Slow-Coagulation Transscleral Cyclophotocoagulation Laser Treatment for Medically Uncontrolled Secondary Aphakic Adult Glaucoma

Abstract

Précis: Slow-coagulation CW-TSCPC is an efficacious, relatively safe, and non-incisional laser treatment option as an initial surgical glaucoma management choice, in secondary aphakic adult glaucoma that is medically uncontrolled. Purpose: This study evaluates the outcomes of slow-coagulation continuous wave transscleral cyclophotocoagulation (CW-TSCPC) laser for treating secondary aphakic adult glaucoma after complicated cataract surgery as a primary surgical intervention. Materials and Methods: A retrospective chart review of adult aphakic eyes with medically uncontrolled glaucoma underwent slow-coagulation CW-TSCPC as a primary surgical glaucoma intervention was performed. Surgical success was the primary outcome measure. Success was defined as postoperative intraocular pressure (IOP) between 6 and 21 mm Hg with ≥20% reduction compared with baseline and no need for further glaucoma surgeries or development of vision-threatening complications. The secondary outcomes included changes in IOP, glaucoma medication numbers, visual acuity, and postoperative complications during the first year after laser treatment after laser treatment. Results: This study included 41 eyes of 41 patients. The mean age of study participants was 66.7±13.1 years, with a mean follow-up duration of 19±3.5 months. At one year, the success rate was 63.4%. A statistically significant reduction of the IOP was observed, with the mean IOP decreasing from 29.6±5.8 mm Hg with a mean of 3.9±1.0 medications at baseline to a mean of 19.0±6.4 mm Hg with a mean of 2.5±1.2 medications at 12 months (P<0.001). Four eyes received CW-TSCPC retreatment, and 2 eyes required incisional glaucoma surgeries. Reported postoperative complications included: visual acuity decline ≥2 lines in 7 eyes, iritis in 6 eyes, hyphema in 5 eyes, cystoid macular edema in 2 eyes, and transient hypotony in 1 eye. Conclusion: Slow-coagulation CW-TSCPC is an efficacious, relatively safe, and non-incisional laser treatment option as an initial surgical glaucoma management choice, in secondary aphakic adult glaucoma that is medically uncontrolled.

Cyclophotocoagulation as a Minimally Invasive Treatment Option for Glaucoma

“…42 The most common cause of decreased VA in the remainder of studies was attributed to glaucoma progression and not as a consequence of the laser treatment. [43][44][45][46][47] MP-TSCPC treatment seems to have a lower risk of losing VA. The incidence of VA decrease ( ≥ 2 lines) is 1% to 26% among different studies.…”

“…In SC-TSCPC, the rates of loss of 2 lines or more of Snellen VA were 12.7% to 32.6%. [42][43][44][45][46][47] It is worth mentioning that the incidence of VA reduction was higher in patients with no prior incisional surgeries; the rate of vision loss was 32.6% (15 eyes), but 9 out of the 15 eyes experienced decreased VA due to cataracts. 42 The most common cause of decreased VA in the remainder of studies was attributed to glaucoma progression and not as a consequence of the laser treatment.…”

“…SC-TSCPC showed encouraging results in the treatment of different glaucoma types with success rates ranging from 60.6% to 72.2%. [42][43][44][45][46][47] One possible explanation for the wide range of reported IOP reduction is the preoperative IOP. Vernon et al 48 reported that in patients with preoperative IOP > 30 mm Hg, 94% of eyes had a reduction in IOP of at least 30% at the last follow-up visit, whereas for those whose initial IOP ≤ 30 mm Hg, 75% achieved such degree of the IOP reduction.…”

“…After SC-TSCPC treatment, patients had reduction in their preoperative glaucoma medications from 4.1 ± 0.9 to 3.1 ± 1.3 in pseudophakic patients with glaucoma, 3.3 ± 1.1 to 2.0 ± 1.5 in neovascular glaucoma (NVG), from 4.2 ± 0.9 to 1.9 ± 1.5 in postvitrectomy glaucoma, 3.9 ± 1.0 to 2.5 ± 1.2 in aphakic glaucomatous patients, and 4.0 ± 1.0 to 2.7 ± 1.4 in patients with postkeratoplasty glaucoma. [43][44][45][46][47] Studies of MP-TSCPC also showed it is effective in reducing both oral and topical medication needed for glaucoma treatment. The mean reduction of glaucoma medication is 0.3 to 1.7 in over 1-year follow-up studies.…”

“…20,21,37 The incidence of CME in conventional CW-TSCPC is 1% to 12.4% 24,51,57,63 and 0% to 8.3% in SC-TSCPC. [42][43][44][45][46][47] Although MP-TSCPC has a good safety profile, the rate of subconjunctival bleeding (probably from the tight sweeping motion of the MP probe against the conjunctiva) is a potential problem. 53…”