Transscleral versus endoscopic cyclophotocoagulation outcomes for refractory glaucoma

Abstract

Objectives: Evaluate the efficacy of transscleral cyclophotocoagulation versus endoscopic cyclophotocoagulation to reduce intraocular pressure. Methods: A retrospective, non-randomized cohort study with 1 year of follow-up included 62 eyes of 62 refractory glaucoma patients who underwent transscleral cyclophotocoagulation or endoscopic cyclophotocoagulation. Results: Thirty-two patients were enrolled in transscleral cyclophotocoagulation group and 30 patients in endoscopic cyclophotocoagulation group, and the follow-up period was 1 year. The mean preoperative intraocular pressure was 35.6 ± 12.9 mm Hg in the transscleral cyclophotocoagulation group and 31.8 ± 8.8 mm Hg in the endoscopic cyclophotocoagulation group without significant difference ( p = 0.18). When we compare both groups, there was no difference at 1 month ( p = 0.46) and 3 months ( p = 0.21) after surgery. However, there was a statistically significant difference at month 6 ( p = 0.0055) and 1 year ( p = 0.0019), finding lower intraocular pressure in the transscleral cyclophotocoagulation group. Cumulative success for intraocular pressure <21 mm Hg was 93.8% in transscleral cyclophotocoagulation group and 83.3% in endoscopic cyclophotocoagulation group after 1 year ( p = 0.2). For intraocular pressure <18 mm Hg, the success rate was 78.1% in transscleral cyclophotocoagulation group and 63.3% in endoscopic cyclophotocoagulation group ( p = 0.06), and for intraocular pressure <16 mm Hg, the success rate was 62.5% in transscleral cyclophotocoagulation group and 43.3% in endoscopic cyclophotocoagulation group ( p = 0.02). Hypotony ( p = 0.01) and vision loss of two lines ( p = 0.01) were statistically significant lower in endoscopic cyclophotocoagulation group. Conclusion: This study demonstrates that both transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation are effective at decreasing intraocular pressure. However, transscleral cyclophotocoagulation is related to more complications than endoscopic cyclophotocoagulation, whereas endoscopic cyclophotocoagulation shows lower intraocular pressure decrease than transscleral cyclophotocoagulation.

An update on continuous‐wave cyclophotocoagulation (CW‐CPC) and micropulse transscleral laser treatment (MP‐TLT) for adult and paediatric refractory glaucoma

“…A randomized clinical trial comparing ECP with alternatives has never been conducted (Tóth et al 2019). To date, only one non‐randomized study has compared ECP (30 patients) to CW‐TSCPC (32 patients) (Lanzagorta‐Aresti et al 2020). It has shown that both ECP and CW‐TSCPC effectively lowered the IOP after a one‐year follow‐up.…”

Complications of Glaucoma Surgery

“…97,110 BCVA loss ≥ 2 was between 6% and 38.8% in these 2 studies. 97,110 Like with other CPC modalities, phthisis is a rare potential complication after ECP. 111…”

“…In medium- to large-sized retrospective studies investigating eyes that had cataract surgery with ECP, adverse events included anterior chamber fibrin (10.6%), macular edema (4.8% to 8.7%), persistent iritis (3.6%), corneal decompensation (2.9%), IOP spike (1.2% to 7.7%), retinal detachment (1.2%), Descemet’s detachment (1.2% to 1.9%), and zonular dialysis (1.0%) 107–109 . In the study by Rodrigues et al,[107] BCVA loss ≥ 2 lines was 2.2% In medium-sized retrospective studies evaluating standalone ECP, adverse events included macular edema (4.8% to 13%), anterior chamber fibrin (2.4% to 33%), persistent iritis (4.8%), hypotony (4.8%), choroidal effusion (3%), corneal decompensation (2.4% to 9.5%), retinal detachment (2.4%), and suprachoroidal hemorrhage (2.4%) 97,110 . BCVA loss ≥2 was between 6% and 38.8% in these 2 studies 97,110 .…”

“…In the study by Rodrigues et al,[107] BCVA loss ≥ 2 lines was 2.2% In medium-sized retrospective studies evaluating standalone ECP, adverse events included macular edema (4.8% to 13%), anterior chamber fibrin (2.4% to 33%), persistent iritis (4.8%), hypotony (4.8%), choroidal effusion (3%), corneal decompensation (2.4% to 9.5%), retinal detachment (2.4%), and suprachoroidal hemorrhage (2.4%) 97,110 . BCVA loss ≥2 was between 6% and 38.8% in these 2 studies 97,110 . Like with other CPC modalities, phthisis is a rare potential complication after ECP 111 …”

Efficacy and safety of transscleral cyclophotocoagulation versus cyclocryotherapy in the treatment of intractable glaucoma: A systematic review and meta‐analysis

“…In the future, more well‐designed RCTs and clinical data with larger sample sizes and longer follow‐ups are warranted. Future research should also look into long‐term outcomes, cost–benefit analysis, and quality‐of‐life measurements and may further investigate newer technologies, if more studies and data are available, such as micropulse transscleral laser therapy, endoscopic cyclophotocoagulation, and high‐intensity focused ultrasound cyclodestructions (Abdelrahman & El Sayed, 2018; Aquino et al, 2015; Beardsley et al, 2017; Giannaccare et al, 2017; Graber et al, 2018; Kraus et al, 2014; Lanzagorta‐Aresti et al, 2021).…”