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Parekh Z, Wang J, Qiu M. Outcomes of slow coagulation transscleral cyclophotocoagulation in a predominantly African American glaucoma population. Am J Ophthalmol Case Rep 2024; 35:102072. [PMID: 38841152 PMCID: PMC11152606 DOI: 10.1016/j.ajoc.2024.102072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Purpose To evaluate outcomes of slow coagulation transscleral cyclophotocoagulation (SC-TSCPC) in a primarily African American patient population with glaucoma. Methods A retrospective chart review was performed for 104 consecutive cases of SC-TSCPC by a single surgeon between November 6, 2019-September 7, 2023. Power ranged from 1150 to 1500 mW, duration was 4 s, and number of spots ranged from 10 to 25. Exclusion criteria were diagnosis of neovascular glaucoma, prior CPC, visual acuity (VA) of no light perception or unable to be assessed due to patient's mental status, aphakia, or follow-up <3 months. The primary outcome measure was surgical success defined as an intraocular pressure (IOP) of 6-21 mmHg with a ≥20 % reduction from baseline, no glaucoma re-operation, and no loss of light-perception. Secondary outcome measures included VA, glaucoma medication use, and post-surgical complications. Analysis was also stratified by lens status as literature suggests a greater IOP-lowering effect in pseudophakic eyes after CPC. Results There were 28 eligible patients (6 phakic, 22 pseudophakic) included in this analysis. Mean follow-up was 11.6 ± 8.3 months, and 14 patients had postoperative year 1 data available. The mean age was 75.2 ± 13.9 years, 42.9 % were female, and 92.9 % were African American, reflective of the demographics of the local community. The cumulative success rate was 68.5 % at 1 year and did not differ significantly between phakic and pseudophakic patients. Mean VA worsened from 20/600 preoperatively to 20/1050 at last follow-up (P = 0.04) and was marginally worse in the phakic group (P = 0.15). Mean IOP decreased from 31.1 ± 13.2 mmHg on 4.0 ± 1.5 medications preoperatively to 13.8 ± 7.1 mmHg on 2.6 ± 1.5 medications at last follow-up (P < 0.001; P < 0.01), with a more pronounced effect among pseudophakic patients. 85.7 % of patients had prolonged anterior chamber (AC) inflammation beyond 1 month, which persisted in 10.7 % at last follow-up. The cystoid macular edema (CME) rate was 21.4 %, with 10.7 % persistent at last follow-up. Conclusions SC-TSCPC is an effective, non-incisional IOP-lowering procedure in phakic and pseudophakic eyes that may not otherwise be ideal candidates for incisional glaucoma surgery. Pseudophakic eyes may experience larger reductions in IOP, however, laser settings can be titrated on a case-by-case basis depending on individual patients' goals. There was a higher incidence of prolonged AC inflammation and CME in our cohort compared to similar studies which report rates of 12.7 % and 2.7 %, respectively. Although the significance of such complications may differ based on the visual potential of each patient, these findings support existing literature that African American patients can have greater incidence of inflammation and subsequent sequalae after ocular surgery.
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Affiliation(s)
- Zaid Parekh
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Jessie Wang
- Department of Ophthalmology & Visual Sciences, University of Chicago, Chicago, IL, USA
| | - Mary Qiu
- Department of Ophthalmology & Visual Sciences, University of Chicago, Chicago, IL, USA
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Senthilkumar VA, Wala N, Rajendrababu S, Mishra C, Kannan NB, Uduman MS. Clinical Presentation and Treatment Outcomes of Pupillary Block Glaucoma Following Vitreoretinal Surgery. Semin Ophthalmol 2024; 39:381-386. [PMID: 38810666 DOI: 10.1080/08820538.2024.2323117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/23/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE To describe the clinical presentation and treatment outcomes of pupillary block glaucoma (PBG) following vitreoretinal surgery (VR surgery). MATERIAL AND METHODS Retrospective observational study of 6941 patients, who underwent VR surgery at a tertiary eye care centre in South India between January 2015 and December 2019. Amongst them, clinical data of 61 patients who developed PBG were taken for statistical analysis. RESULTS Mean (SD) age was 53.90 (13.4) years and the incidence of PBG was .87%. Median (IQR) time of onset of PBG following VR surgery was 3.33 (1.1-6.6) months and majority were pseudophakic (75%). PBG resolved with Nd:YAG laser peripheral iridotomy (LPI) alone in 50 (82%) patients, whereas 11(18%) patients required additional interventions like surgical iridectomy, trabeculectomy or diode laser cyclophotocoagulation (CPC) either as a stand-alone procedure or in combination with silicone oil removal (SOR). Mean (SD) intraocular pressure at the onset of PBG was 41.61 (14.5) mmHg, which reduced drastically following LPI to 24.28 (14.9) mmHg which further dropped significantly at 6 months follow up to 20.34 (13.9) mmHg. CONCLUSIONS Incidence of secondary PBG after VR surgery was .87%, and we observed diabetes mellitus, combined cataract and VR surgery, use of 1000cs SO endotamponade, intraoperative endolaser and multiple VR surgical interventions as common associations. Majority of the patients with PBG after VR procedures resolved with LPI and medical management. Few individuals (18%) required additional laser or surgical intervention for IOP control.
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Affiliation(s)
- Vijayalakshmi A Senthilkumar
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate institute of ophthalmology, Madurai, Tamilnadu, India
| | - Narendra Wala
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate institute of ophthalmology, Madurai, Tamilnadu, India
| | - Sharmila Rajendrababu
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate institute of ophthalmology, Madurai, Tamilnadu, India
| | - Chitaranjan Mishra
- Department of Retina and Vitreoretinal surgery, Aravind Eye Hospital and Postgraduate Institute of ophthalmology, Madurai, Tamilnadu, India
| | - Naresh Babu Kannan
- Head of the department, Department of Retina and Vitreoretinal surgery, Aravind Eye Hospital and Postgraduate Institute of ophthalmology, Madurai, Tamilnadu, India
| | - Mohammed Sithiq Uduman
- Department of Biostatistics, Aravind Eye Hospital and Postgraduate Institute of ophthalmology, Madurai, Tamilnadu, India
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Sari C, Alagoz N, Omeroglu A, Cakir I, Pasaoglu I, Altan C, Yasar T. Long-Term Results of Transscleral Diode Laser Cyclophotocoagulation in Glaucoma: A Real-Life Study. J Glaucoma 2024; 33:437-443. [PMID: 38129950 DOI: 10.1097/ijg.0000000000002346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
PRCIS Transscleral diode laser cyclophotocoagulation (TDLC) is effective and safe in a large population and different types of glaucoma but is least effective in the neovascular glaucoma (NVG) group. OBJECTIVE We aimed to investigate the clinical outcomes of TDLC in a large cohort of patients with different types of refractory glaucoma. PATIENTS AND METHODS Using patient charts, we retrospectively analyzed the success and complications of TDLC performed on eyes categorized into 6 groups: primary glaucoma (116 eyes), trauma (41 eyes), NVG (84 eyes), post-vitreoretinal surgery (post-VRS, 79 eyes), penetrating keratoplasty (47 eyes), and miscellaneous (40 eyes). Failure was defined as intraocular pressure (IOP) >22 mm Hg or <5 mm Hg, the need for further glaucoma surgery, and the loss of light perception during follow-up. RESULTS Overall, the mean follow-up time was 33.4 ± 17.4 months, the mean total energy delivered was 109.2 ± 56.5 J, and the mean IOP reduction rate was 41.8%. Total energy delivered and IOP reduction rates were similar between the groups (all P > 0.05). The probability of success at 36 months was 71.5%, 70.7%, 55.9%, 77.2%, 72.3%, and 72.5% in primary glaucoma, trauma, NVG, post-VRS, penetrating keratoplasty, and miscellaneous groups, respectively. The NVG group showed a significantly lower success rate ( P = 0.009) than the other groups. Significant complications consisted of phthisis bulbi in 1 eye (0.2%) in the NVG group and chronic hypotony in 7 eyes (1.7%) in the NVG (3 eyes), trauma (2 eyes), post-VRS (1 eye), and primary glaucoma (1 eye) groups. CONCLUSIONS Although TDLC was found to be a safe, effective method in the long term, it was least effective in eyes with NVG.
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Affiliation(s)
- Cem Sari
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Kelada M, Normando EM, Cordeiro FM, Crawley L, Ahmed F, Ameen S, Vig N, Bloom P. Cyclodiode vs micropulse transscleral laser treatment. Eye (Lond) 2024; 38:1477-1484. [PMID: 38291347 PMCID: PMC11126682 DOI: 10.1038/s41433-024-02929-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Continuous-wave transscleral cyclophotocoagulation (CW-TSCP) is usually reserved for advanced/refractory glaucoma. Micropulse transscleral laser therapy (MPTLT) utilises short energy pulses separated by 'off'-periods. MPTLT is postulated to have fewer complications, but its relative efficacy is not known. The National Institute for Health and Care Excellence (NICE) has deemed the evidence supporting MPTLT use of inadequate quality, limiting its use to research. This study aims to evaluate MPTLT efficacy and safety compared to CW-TSCP. METHODS This 24-month follow-up retrospective audit included 85 CW-TSCP and 173 MPTLT eyes at a London tertiary referral centre. Primary outcome was success rate at the last follow-up; defined as at least 20% intraocular pressure (IOP) reduction with the same/fewer medications, and IOP between 6 and 18 mmHg. Secondary outcomes were acetazolamide use and success rates per glaucoma type. Safety outcomes were reported as complication rates. RESULTS By 24-months, mean IOP reduced from 34.6[±1.4]mmHg to 19.0[ ± 3.0]mmHg post-CW-TSCP (p < 0.0001); and from 26.1[±0.8]mmHg to 19.1[±2.2]mmHg post-MPTLT (p < 0.0001). Average IOP decreased by 45.1% post-CW-TSCP, and 26.8% post-MPTLT. Both interventions reduced medication requirements (p ≤ 0.05). More CW-TSCP patients discontinued acetazolamide (p = 0.047). Overall success rate was 26.6% for CW-TSCP and 30.6% for MPTLT (p = 0.83). Only primary closed-angle glaucoma saw a significantly higher success rate following CW-TSCP (p = 0.014). CW-TSCP complication rate was significantly higher than MPTLT (p = 0.0048). CONCLUSION Both treatments significantly reduced IOP and medication load. CW-TSCP had a greater absolute/proportionate IOP-lowering effect, but it carried a significantly greater risk of sight-threatening complications. Further prospective studies are required to evaluate MPTLT compared to CW-TSCP.
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Affiliation(s)
- Monica Kelada
- Imperial College School of Medicine, Imperial College London, London, UK.
| | - Eduardo M Normando
- Imperial College School of Medicine, Imperial College London, London, UK
- ICORG, Department of Surgery & Cancer, Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Francesca M Cordeiro
- ICORG, Department of Surgery & Cancer, Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Laura Crawley
- ICORG, Department of Surgery & Cancer, Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Faisal Ahmed
- ICORG, Department of Surgery & Cancer, Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sally Ameen
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Niten Vig
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Philip Bloom
- ICORG, Department of Surgery & Cancer, Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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Thattaruthody F, Chauhan N, Choudhary S, Raj S, Pandav SS, Kaushik S. Efficacy of a novel low-cost torchlight transcorneal transillumination for diode laser transscleral cyclophotocoagulation in adult glaucoma. Eur J Ophthalmol 2024:11206721241253305. [PMID: 38710194 DOI: 10.1177/11206721241253305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
PURPOSE To study the outcomes of diode laser transscleral cyclophotocoagulation (TSCPC) with trans-corneal transillumination using a novel low-cost torchlight method in refractory glaucoma. METHODS AND ANALYSIS This prospective interventional study included patients with refractory glaucoma who underwent TSCPC with trans-corneal transillumination (TSCPC-TI) using a novel low-cost torchlight method. Patients completing a minimum 6-month follow-up were analyzed. They were compared to a historical control group of patients who underwent TSCPC without transillumination (TSCPC-No TI) at 6-month follow-up period. We analyzed the mean laser energy delivered, post-laser intraocular pressure (IOP) reduction, number of antiglaucoma medications (AGM), the requirement of retreatment and complications of the procedure in both groups. RESULTS 32 eyes of 29 patients comprised the TSCPC-TI group and were compared with 39 eyes of 37 patients in the TSCPC-No TI group. The TSCPC-TI group required lower energy than the TSCPC-No TI group (46.15 ± 22.8 Vs 80.65 ± 56.1 J p < 0.001). At 6-month follow-up, the TSCPC-TI group required lesser AGM for IOP control (2.33 ± 1.02 vs 3.02 ± 1.32 p = 0.01). There was a significantly reduced dependence of oral acetazolamide in the TSCPC-TI group at 6 months follow-up (15.6% vs 41% p = 0.03%). The success and response rates were 71.8% Vs 23.1%; p < 0.0001 and 87.5% Vs 51.2%; p = 0.001 significantly high in the TSCPC-TI group. The TSCPC-No TI group had a significantly high failure rate (12.5% Vs 48.2% p = 0.001). Hypotony (n = 1) and phthisis (n = 2) were noted TSCPC-No TI group. CONCLUSIONS TSCPC with transillumination with a low-cost torchlight resulted in a more efficient and effective cycloablation than TSCPC without transillumination.
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Affiliation(s)
- Faisal Thattaruthody
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Chauhan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Choudhary
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Srishti Raj
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Pandav
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Kaushik
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Raja V, Balasubramaniam N, Sundar B, Nagdev N. The outcomes of diode laser transscleral cyclophotocoagulation in refractory primary angle-closure glaucoma in a South Indian population. Indian J Ophthalmol 2024; 72:397-401. [PMID: 38099577 PMCID: PMC11001240 DOI: 10.4103/ijo.ijo_1129_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/16/2023] [Accepted: 08/04/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The surgical intervention of refractory primary angle-closure glaucomas (PACGs) is a big challenge to any ophthalmologist since the efficacy of lens extraction in eyes with a long duration of angle closure is limited. Also, trabeculectomy in such eyes is not without vision-threatening complications. PURPOSE To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation (CPC) in eyes with refractory PACG. METHODS A retrospective study analyzing all patients who underwent CPC for refractory PACG in the year 2019 was conducted. Out of the 68 patients recruited, 56 PACG patients fulfilled the study criteria. RESULTS The mean age of the participants was 58.5 years. The mean (standard deviation [SD]) intraocular pressure (IOP) at baseline was 38.91 (14.86) mmHg, and it ranged from 21 to 74 mmHg. Participants' mean (SD) follow-up duration was 11.87 (7.83) months. Almost 90.9% of eyes showed IOP reduction from baseline during the follow-up period. There was also a reduction in the mean antiglaucoma medications (AGM) to 2.67 (1.29) in the final follow-up visit compared to the baseline of 3.30 (0.81). Chronic hypotony was noted in four eyes, out of which phthisis bulbi occurred in one eye. Six eyes underwent additional incisional surgical procedures. CONCLUSION The outcomes from our study support the role of transscleral diode laser CPC in the interim optimization of IOP in PACG eyes refractory to other modalities. This is emerging as a primary treatment option to optimize IOP to safer limits before any planned incisional procedure. Though complications like chronic hypotony occur as anticipated, vision-threatening complications are rare.
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Affiliation(s)
- Vidya Raja
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Anna Nagar, Madurai, Tamil Nadu, India
| | - Niranjana Balasubramaniam
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Anna Nagar, Madurai, Tamil Nadu, India
| | - Balagiri Sundar
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Anna Nagar, Madurai, Tamil Nadu, India
| | - Nimrita Nagdev
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Anna Nagar, Madurai, Tamil Nadu, India
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Greslechner R, Helbig H. [Neovascular Glaucomas - Pathogenesis, Diagnosis, Treatment and Prophylaxis]. Klin Monbl Augenheilkd 2023. [PMID: 37977202 DOI: 10.1055/a-2193-2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Neovascular glaucoma (NVG) is a severe potentially blinding disease, which represents one of the most common types of secondary glaucomas. The majority of cases are caused by ischemic retinal conditions such as diabetic retinopathy, central retinal vein occlusion or ocular ischemic syndrome. If appropriately diagnosed and treated, ideally the development of NVG can be prevented. Since treatment gets increasingly challenging as the disease progresses, early diagnosis is of utmost importance. In this review pathogenesis, diagnosis, treatment and prophylaxis are discussed extensively. A focus is put on the consecutive stages through which the disease progresses and how to diagnose and differentiate them. Ultimately a stage adapted therapy approach is detailed, consisting of the three blocks: 1. treatment of the underlying disease/retinal ischemia, 2. adjunctive medical therapy (anti-VEGF) and 3. therapy of the elevated intraocular pressure.
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Lin F, Nie X, Shi J, Song Y, Lv A, Li X, Lu P, Zhang H, Jin L, Tang G, Fan S, Weinreb RN, Zhang X. Safety and Efficacy of Goniotomy following Failed Surgery for Glaucoma. J Glaucoma 2023; 32:942-947. [PMID: 37725785 DOI: 10.1097/ijg.0000000000002301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023]
Abstract
PRCIS Goniotomy (GT) is an alternative surgery for patients with prior failed surgery for glaucoma. PURPOSE To evaluate the efficacy and safety of GT in patients with prior failed surgery for glaucoma. MATERIALS AND METHODS A prospective, observational multicentered study was performed for patients who underwent GT with prior single or multiple surgery for glaucoma. Outcome measures included intraocular pressure (IOP) change, best-corrected visual acuity change, ocular hypotensive medication use, and occurrence of adverse events through 12 months. Complete success was defined as a postoperative IOP within 6-18 mmHg and a 20% reduction from baseline without ocular hypotensive medications. Qualified success was the same as the definition of complete success, except for postoperative use of medication. Logistic regression models were used to investigate the potential factors for surgical success. RESULTS A total of 38 eyes of 34 patients were included. Twenty-three eyes had only 1 prior surgery, 13 eyes had 2 prior surgeries, 1 eye had 3 prior surgeries, and 1 eye had 4 prior surgeries. At month 12, there was complete success in 42.1% of the eyes and qualified success in 78.9% of the eyes. Preoperatively, the mean IOP was 29.4±6.9 mmHg and the median number of glaucoma medications used was 3.0 (2.0, 4.0); this decreased to 16.7±3.6 mmHg (43.2% reduction; P <0.001) and 2.0 (0.0, 3.0) ( P <0.001) at month 12, respectively. The most common complications included hyphema (13.2%), IOP spike (7.9%), and corneal edema (5.2%). Older age significantly contributed to surgical success. CONCLUSIONS GT seems to be a safe and effective procedure for patients with prior failed surgery for glaucoma.
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Affiliation(s)
- Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Xin Nie
- Department of Ophthalmology, Chongqing General Hospital, Chongqing
| | | | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
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Khodeiry MM, Elhusseiny AM, Liu X, Sayed MS, Lee RK. Cyclophotocoagulation as a Minimally Invasive Treatment Option for Glaucoma. Int Ophthalmol Clin 2023; 63:125-135. [PMID: 37755447 PMCID: PMC10539019 DOI: 10.1097/iio.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Historically, the complications and inadequate efficacy of prior cyclodestructive procedures limited their role in glaucoma management. Recent advances in treatment techniques and parameters for laser cyclophotocoagulation has expanded its role in today's glaucoma practice. This review summarizes the role of different cyclophotocoagulation techniques, including continuous wave transscleral cyclophotocoagulation and micropulse transscleral cyclophotocoagulation, in the management of glaucomatous optic neuropathy.
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Affiliation(s)
- Mohamed M. Khodeiry
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abdelrahman M. Elhusseiny
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xiangxiang Liu
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | - Richard K. Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Bai A, Sharma A, Chiang MY. Proliferative Vitreoretinopathy Following Transscleral Diode Cyclophotocoagulation. J Glaucoma 2023; 32:e66-e68. [PMID: 37054434 DOI: 10.1097/ijg.0000000000002222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/18/2023] [Indexed: 04/15/2023]
Abstract
PRCIS Transscleral diode laser cyclophotocoagulation may trigger the development of proliferative vitreoretinopathy. Our article demonstrates one such case leading to tractional macula-off retinal detachment in a child with aphakic glaucoma. PURPOSE The purpose of this article is to describe a case of proliferative vitreoretinopathy (PVR) developing subsequent to transscleral diode laser cyclophotocoagulation (cyclodiode) in a pediatric patient with aphakic glaucoma. PVR most commonly occurs following rhegmatogenous retinal detachment repair; however, to the best of our knowledge, it has never been reported to appear after cyclodiode. METHODS Retrospective evaluation of case presentation and intraoperative findings. RESULTS A 13-year-old girl with aphakic glaucoma presented 4 months after cyclodiode of the right eye with a retrolental fibrovascular membrane and anterior PVR. The PVR extended posteriorly over the next month, after which the patient developed a tractional macula-off retinal detachment. Pars Plana vitrectomy was performed, confirming dense anterior and posterior PVR. A review of the literature suggests that an inflammatory cascade, similar to that seen in PVR development following rhegmatogenous retinal detachment, may occur from the destruction of the ciliary body by cyclodiode. As a result, fibrous transformation may occur, likely accounting for the cause of PVR development in this case. CONCLUSION The pathophysiology of PVR development remains unclear. This case demonstrates that PVR may occur following cyclodiode and should be considered during postoperative monitoring after this procedure.
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Affiliation(s)
- Amelia Bai
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane, Australia
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Scott TM, Ting ER, Vincent SJ, Lee GA. Long-term limitations and complications of trans-scleral diode laser cycloablation for refractory glaucoma. Clin Exp Ophthalmol 2023; 51:131-136. [PMID: 36307903 DOI: 10.1111/ceo.14185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/07/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Trans-scleral diode laser cycloablation (cyclodiode) is effective in the short-term management of refractory glaucoma where alternative treatments are not feasible. Long-term outcomes of 5-years or more are not well-documented, particularly in relation to intraocular pressure (IOP) control, need for further procedures and complications such as hypotony and phthisis. METHODS A review was undertaken of patient medical records with refractory glaucoma who underwent cyclodiode at City Eye Centre in Brisbane from 2012 to 2016. Data included sex, age, laterality, type of glaucoma, cyclodiode parameters, number of glaucoma medications, visual acuity and treatment with acetazolamide. Data were analysed using generalised linear modelling and Kaplan-Meier analysis. RESULTS A total of 54 eyes in 54 patients (29 M:25F) with a mean age of 66 years (range 15-85 years) with a minimum of 5 years follow up were included. The mean number of burns was 23.3 (range 12-40) over 180-270 degrees, mean power per burn was 1967 mW (range 1500-2000 mW), with a mean duration of 1981 ms (1500-2000 ms). The mean pre-treatment IOP was 31.5 mmHg (range 17-56 mmHg) and mean IOP 5 years post-treatment was 16.1 mmHg (2-42 mmHg). The mean number of pre-treatment medications was 3.6 (range 1-6) and 2.7 (range 0-5) 5 years post treatment, including 5 (8.3%) on oral acetazolamide. Complications of cyclodiode were seen in 6 (11.1%) patients, including 3 (5.0%) cases of hypotony, and 2 (3.3%) phthisis. CONCLUSION Cyclodiode is often utilised for end-stage glaucoma when the IOP is uncontrolled on medical treatment and drainage surgery is not indicated, resulting in long-term reduction of IOP and the number of medications, including acetazolamide. Hypotony and phthisis can be significant complications.
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Affiliation(s)
- Tabitha M Scott
- City Eye Centre, Brisbane, QLD, Australia.,Mayne Academy of Surgery, University of Queensland, Herston, QLD, Australia
| | | | - Stephen J Vincent
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Graham A Lee
- City Eye Centre, Brisbane, QLD, Australia.,Mayne Academy of Surgery, University of Queensland, Herston, QLD, Australia.,Department of Ophthalmology, The Mater Hospital, Brisbane, QLD, Australia
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12
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Akiyama T, Fujishiro T, Sugimoto K, Sakata R, Saito H, Honjo M, Aihara M. Short-term outcomes of micropulse transscleral laser therapy using the revised delivery probe in refractory glaucoma. Jpn J Ophthalmol 2022; 66:549-558. [PMID: 35976502 DOI: 10.1007/s10384-022-00938-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the effectiveness of MicroPulse® transscleral laser therapy (MP-TLT) using both the original and revised MicroPulse P3® delivery probes in patients with refractory glaucoma. STUDY DESIGN Retrospective study METHODS: We analyzed the data of patients with refractory glaucoma who underwent MP-TLT with the original and with the revised MicroPulse P3® Delivery Device from January 2018 to December 2020 at the University of Tokyo Hospital and who were followed up for 3 months. Patients' demographics, preoperative and postoperative intraocular pressure (IOP), medication scores, best-corrected visual acuity (BCVA), and complications were analyzed. RESULTS This study enrolled 40 patients in both probe groups. At baseline, the mean IOP was 31.1 mmHg in the original group and 29.2 mmHg in the revised group, and it decreased to 22.6 mmHg and 21.6 mmHg after 3 months, respectively (paired t-test p=0.001, 0.001). No significant difference was noted between the number of medications and BCVA at baseline and 3 months in either probe group (paired t-test, p>0.05). Nor were any serious complications observed. CONCLUSION MP-TLT using the revised MicroPulse P3® Delivery Device for the treatment of refractory glaucoma was effective in reducing IOP across glaucoma types with an excellent safety profile and was well-tolerated by the patients.
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Affiliation(s)
- Takuya Akiyama
- Department of Ophthalmology, Asahi General Hospital, Asahi, Japan
| | - Takashi Fujishiro
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Bunkyo-ku, Tokyo, Japan.
| | - Koichiro Sugimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Rei Sakata
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Hitomi Saito
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo Hospital, 7-3-1, Bunkyo-ku, Tokyo, Japan
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13
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Valle IT, Bazarra SP, Taboas MF, Cid SR, Diaz MDA. Medium-term Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma. J Curr Glaucoma Pract 2022; 16:91-95. [PMID: 36128078 PMCID: PMC9452714 DOI: 10.5005/jp-journals-10078-1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/18/2022] [Indexed: 12/05/2022] Open
Abstract
Aim To describe our first experience with the efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) procedure in the treatment of different glaucoma subtypes refractory to topical medication using a standard protocol. Materials and methods Retrospective, interventional study in a series of 35 eyes of 34 patients with refractory glaucoma who underwent MP-TSCPC. Treatment success was defined as an intraocular pressure (IOP) reduction of at least 20% compared to baseline with or without IOP-lowering medication or eventual retreatment. Results Mean age was 78.0 years. The glaucoma subtypes included pseudoexfoliative (PSXG) (16), neovascular (NVG) (9), primary open-angle (POAG) (7), congenital (1), aphakic (1), and secondary glaucoma (1). The mean preoperative IOP was 31.8 ± 10.5 mm Hg and at month 12 was 21.9 ± 10.6 mm Hg (p < 0.05). The average baseline number of glaucoma medications pretreatment was 3.0 ± 1.0 and at month 12 was 2.3 ± 1.2 (p = 0.114). At month 12, success was achieved in 15 eyes (42.9%) with an IOP-lowering effect of 31.1%. PSXG was correlated with IOP reduction (p = 0.037) and had a higher likelihood of success (p = 0.031). As complications, there was one case of prolonged hypotony and another case of developed postoperative neurotrophic keratopathy. Conclusion Using our standardized protocol, MP-TSCPC seems a safe and relatively effective treatment in the medium-term for refractory glaucoma, achieving good results in PSXG. Clinical significance There are few studies published about MP-TSCPC. The results of our study contribute to expanding on the short evidence reported at present, emphasizing our considerable percentage of PSGX. How to cite this article Valle IT, Bazarra SP, Taboas MF, et al. Medium-term Outcomes of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma. J Curr Glaucoma Pract 2022;16(2):91-95.
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Affiliation(s)
- Inigo Tejada Valle
- Department of Ophthalmology, Complexo Hospitalario Arquitecto Marcide, Ferrol, A Coruña, Spain
- Inigo Tejada Valle, Department of Ophthalmology, Complexo Hospitalario Arquitecto Marcide, Ferrol, A Coruña, Spain, Phone: +34646647652, e-mail:
| | - Sara Pose Bazarra
- Department of Ophthalmology, Complexo Hospitalario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Miguel Ferreira Taboas
- Department of Ophthalmology, Complexo Hospitalario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Sara Rubio Cid
- Department of Ophthalmology, Complexo Hospitalario Arquitecto Marcide, Ferrol, A Coruña, Spain
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14
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A Bakr M, A Moustafa U, Al-Subaie M, A Alfayyadh M. The role trans-sclera MP-CPC as a primary treatment option in congenital glaucoma management. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2108790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Medhat A Bakr
- Ophthalmology Department (Glaucoma Section), Immam Abdulrahman Bin Faisal University, King Fahd University Hospital, Al Khobar, Kingdom of Saudi Arabia
| | - Ussama A Moustafa
- Dhahran Eye Specialist Hospital (DESH), Ministry of Health, Hanoi, Kingdom of Saudi Arabia
| | - Majedd Al-Subaie
- Dhahran Eye Specialist Hospital (DESH), Ministry of Health, Hanoi, Kingdom of Saudi Arabia
| | - Mohammed A Alfayyadh
- Prince Mutaib Bin Abdulaziz Hospital, Aljouf, Ministry of Health, Hanoi, Kingdom of Saudi Arabia
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15
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Efficacy and Safety of Micropulse Transscleral Cyclophotocoagulation. J Clin Med 2022; 11:jcm11123447. [PMID: 35743514 PMCID: PMC9224545 DOI: 10.3390/jcm11123447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Early studies have shown that micropulse transscleral cyclophotocoagulation (MP-TSCPC) might be an effective and safe treatment option for lowering intraocular pressure (IOP). These studies were, however, somewhat limited, in particular by their retrospective nature and the length of follow-up. Therefore, we assessed the efficacy and safety of this novel treatment in a large cohort for up to 4 years. Methods: We performed a prospective cohort study, including all patients who were treated with MP-TSCPC since November 2017. The primary outcome was a reduction of IOP and the number of IOP-lowering medications. Results: The mean ± standard deviation baseline IOP and number of IOP-lowering medications were 26.6 ± 10.8 mmHg and 3.3 ± 1.3. IOP was reduced by 8.2 ± 7.9 (31.8% reduction), 6.9 ± 8.7 (28.1% reduction), and 7.1 ± 8.4 (30.2% reduction) mmHg after 6, 12, and 24 months, respectively (p < 0.001). The mean postoperative number of IOP-lowering medications was significantly reduced after 6 months by 0.6 ± 1.5 (p = 0.002) but was not significantly different after 12 or 24 months. Oral acetazolamide was significantly reduced from 28 (29%) eyes before treatment, to 9 (9%) at the last follow-up visit (p < 0.001). No major complications were observed after treatment. Conclusions: MP-TSCPC is a safe and effective treatment option for lowering IOP, but only reduced IOP-lowering medications in the first 6 months after treatment. However, MP-TSCPC is especially effective in getting patients off oral IOP-lowering drugs.
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16
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Greslechner R, Helbig H. Sekundärglaukome im Rahmen retinaler Erkrankungen. Klin Monbl Augenheilkd 2022; 239:1111-1118. [PMID: 35288886 DOI: 10.1055/a-1797-5188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung:
Eine Vielzahl retinaler Erkrankungen kann zur Entwicklung eines Glaukoms führen. Die häufigste Form dieser Sekundärglaukome sind die Neovaskularisationsglaukome, die den Hauptteil dieser Übersicht bilden. Dabei handelt sich um ein schwerwiegendes Krankheitsbild, dass in mehreren Stadien verläuft, wobei die Prognose mit zunehmendem Stadium ungünstiger und die Therapie herausfordernder wird. Neben Pathogenese und Diagnostik wird daher ein Schwerpunkt wird auf die Früherkennung und eine an das jeweilige Krankheitsstadium angepasste Therapie gelegt.
Auch seltenere Sekundärglaukome im Rahmen intraokularer Tumore sowie Glaukome assoziiert mit einer Netzhautablösung (Schwartz-Matsuo Syndrom) und Glaukome, die im Spätverlauf nach unkomplizierter Vitrektomie auftreten, werden in dieser Übersicht diskutiert.
Abstract:
A variety of retinal diseases can lead to the development of glaucoma. The most common type of these secondary glaucomas is neovascular glaucoma (NVG), which constitutes the main subject of this review.
NVG is a severe condition with a poor prognosis. Treatment gets increasingly challenging as the disease progresses. Thus emphasis is put on early diagnosis and an stage adjusted therapy.
Other less frequent secondary glaucomas, such as glaucomas due to intraocular tumors or associated with retinal detachment (Schwartz-Matsuo syndrome) and late onset open-angle glaucomas after uncomplicated vitrectomy are covered.
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Affiliation(s)
- Roman Greslechner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Klinikum der Universität Regensburg, Regensburg, Germany
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17
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Raja V, Nagdev N, Saurabh K, Reddy S. Role of trans-scleral diode cyclophotocoagulation in refractory glaucoma: A large retrospective study. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_27_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Khomchik OV, Yusef NY, Gamidov AA, Gavrilina PD. [Technique for laser activation of scleral hydropermeability in the treatment of patients with refractory forms of glaucoma]. Vestn Oftalmol 2021; 137:82-86. [PMID: 34965072 DOI: 10.17116/oftalma202113706182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Laser cyclodestructive interventions are considered the method of choice in the treatment of refractory glaucoma. However, the traumatic nature of cyclocoagulation makes it necessary to search for more gentle methods of laser treatment. One of the possible directions is the development of laser transscleral technologies that mainly affect the uveoscleral outflow. This article presents a new technique for laser activation of scleral hydropermeability (LASH) using pulse-periodic erbium glass (Er-glass) fiber-optics laser with wave length of 1.56 μm. The article describes the parameters of laser emission and the technique of LASH, and presents the mechanism of reducing intraocular pressure associated with increased transcleral drainage of intraocular fluid by forming new pores in the sclera. The effectiveness and safety of LASH is supported by a detailed example from clinical practice. This technology has proven itself as a possible alternative to the conventional contact transcleral cyclocoagulation.
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Affiliation(s)
- O V Khomchik
- Research Institute of Eye Diseases, Moscow, Russia
| | - N Y Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - A A Gamidov
- Research Institute of Eye Diseases, Moscow, Russia
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19
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Nowroozzadeh MH, Thornton S, Watson A, Syed ZA, Razeghinejad R. Ocular manifestations of endocrine disorders. Clin Exp Optom 2021; 105:105-116. [PMID: 34751097 DOI: 10.1080/08164622.2021.1986354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Endocrinopathies are prevalent diseases that typically affect multiple organs, and the eye and orbital tissues are often involved in endocrine disorders. Some conditions, such as diabetes and thyroid gland dysfunction, may cause serious eye pathology and even blindness. A clear insight into the pathogenesis of endocrinopathies and their ocular manifestations would enhance preventive and therapeutic measures and reduce the incidence of sight-threatening complications. This review discusses the ocular manifestations of several endocrine disorders that eye care providers are likely to encounter in clinical practice.
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Affiliation(s)
- M Hossein Nowroozzadeh
- Retina Service, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sarah Thornton
- Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Alison Watson
- Oculoplastic Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Zeba A Syed
- Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
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20
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Assessment of Vascular Changes in Patients after Pars Plana Vitrectomy Surgery Due to Macula-Off Rhegmatogenous Retinal Detachment. J Clin Med 2021; 10:jcm10215054. [PMID: 34768574 PMCID: PMC8584379 DOI: 10.3390/jcm10215054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to investigate the changes in the retinal capillary plexuses in patients after pars plana vitrectomy (PPV), which is used for the treatment of rhegmatogenous retinal detachment (RRD). In this study, we included the results of 114 patients who underwent PPV after total retinal detachment (RRD; retinal detachment group). It should be kept in mind that to qualify for the study group, there was a condition that retinal detachment be only present in one eye, allowing the fellow healthy eye to be used for the control group, and the study, therefore, did not include cases where retinal detachment occurred binocularly. Optical coherence tomography (OCT) and OCT-A images were taken at 9 ± 2 months (median 10 months) after the surgery, with the study conducted in the years 2017–2019. OCT was used to examine the external limiting membrane (ELM), central macular thickness (CMT) and retinal nerve fiber layer (RNFL), while OCT-angiography (OCT-A) was used to examine the extent of the foveal avascular zone (FAZ) in the deep and superficial capillary plexuses. Changes in the FAZ area of the superficial plexus (SCP) between the study and control groups were analyzed over 346 ± 50 days. In our study, we observed changes in the FAZ area between the RRD and control groups in the SCP (203.65 ± 31.69 μm2 vs. 215.30 ± 35.82 μm2; p = 0.28733) and DCP (284.79 ± 35.82 µm2 vs. 336.84 ± 32.23 µm2; p = 0.00924). Changes in the RNFL thickness between the study and control groups over 346 ± 50 days were as follows: 90.15 μm vs. 82.44 μm; p = 0.19773. Disruption of the external limiting membrane was observed in 78.95% (90 eyes) of the study group. In the control group, it was undamaged, and no integrity disorder was observed. In the RRD, changes occurred in the FAZ of both the SCP and the DCP, which reduced the extent of this zone, an effect that was more pronounced in DCPs. A better understanding of the anatomical and hemodynamic changes taking place in the retina after macula-off RRD might be helpful in answering the question as to why BCVA in these cases is “only” or “as much as” from 0.4 to 0.1, namely, that it might be related to changes in the neurosensory retina after macular peeling.
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21
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Mohite AA, Samia-Aly E, Ramanathan US, Corridan PG, Murthy S. Does prior endoscopic cyclophotocoagulation (ECP) affect subsequent trabeculectomy outcomes? Graefes Arch Clin Exp Ophthalmol 2021; 260:1975-1982. [PMID: 34694456 PMCID: PMC8543106 DOI: 10.1007/s00417-021-05471-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/07/2021] [Accepted: 10/16/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To report long-term outcomes of trabeculectomy following prior endoscopic cyclophotocoagulation (ECP). Methods Retrospective case-controlled comparative study reporting 2-year outcomes of eyes undergoing trabeculectomy following failed prior ECP (group 1), using eyes undergoing trabeculectomy as a primary glaucoma procedure as controls (group 2). Results Filtration surgery was required in only 19.4% (12/62) of eyes undergoing ECP. Of these, nine eyes that underwent trabeculectomies were included in group 1. Nine matched eyes were used as controls and included in group 2. Mean baseline IOPs were 23.7 ± 7.7 and 26.0 ± 6.7 mmHg (p = 0.452) in groups 1 and 2, respectively, on a mean of 3.4 ± 0.9 and 2.8 ± 1.4 medications, respectively (p = 0.274). The mean 2-year IOP was 10.6 ± 5.2 and 12.9 ± 4.0 mmHg (p = 0.285) in groups 1 and 2, respectively, on a mean of 0.1 ± 0.3 and 0.1 ± 0.4 medications (p = 0.931) respectively. Complete success rates were 77.8% and 88.9% in groups 1 and 2, respectively (p = 0.527). Qualified success rates were 11.1% in both groups. Combined success rates were 88.9% and 100.0% in groups 1 and 2, respectively (p = 0.318). There were no failures in group 2, compared to 11.1% in group 1 (p = 0.318). There were no significant between-group differences in hypotony, bleb needling, cystoid macular oedema, persistent uveitis, or repeat filtration surgery rates. Conclusions ECP is a safe initial procedure in eyes with progressive glaucomas, and may substantially reduce the need for trabeculectomy without compromising outcomes in the minority that go on to require it.
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Affiliation(s)
- Abhijit Anand Mohite
- Wolverhampton and Midland Counties Eye Infirmary, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK.
| | - Emma Samia-Aly
- Wolverhampton and Midland Counties Eye Infirmary, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - Uthaya Shankar Ramanathan
- Wolverhampton and Midland Counties Eye Infirmary, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - Patrick G Corridan
- Wolverhampton and Midland Counties Eye Infirmary, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - Shashidhar Murthy
- Wolverhampton and Midland Counties Eye Infirmary, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
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22
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Khodeiry MM, Liu X, Sheheitli H, Sayed MS, Lee RK. Slow Coagulation Transscleral Cyclophotocoagulation for Postvitrectomy Patients With Silicone Oil-induced Glaucoma. J Glaucoma 2021; 30:789-794. [PMID: 34049347 PMCID: PMC8404953 DOI: 10.1097/ijg.0000000000001893] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
PRECIS Slow coagulation transscleral cyclophotocoagulation (TSCPC) is an effective and safe glaucoma surgery in patients with medically uncontrolled silicone oil (SO)-induced glaucoma. PURPOSE The purpose of this study was to report the outcomes of slow coagulation continuous wave TSCPC in patients with medically uncontrolled secondary glaucoma following pars plana vitrectomy (PPV) and intravitreal SO injection. PATIENTS AND METHODS This retrospective study enrolled patients with medically uncontrolled glaucoma secondary to PPV with SO injection who underwent TSCPC using slow coagulation TSCPC settings (power of 1250 mW and duration of 4 s). The primary outcome measure was surgical success at 12 months. Surgical success was defined as an intraocular pressure 6 to 21 mm Hg and reduced ≥20% from baseline, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures included number of glaucoma medications, visual acuity changes, and surgical complications. RESULTS A total of 18 eyes of 18 patients were included in the study. The mean age and follow-up of the patients were 51.94±14.5 years and 16.3±3.5 months, respectively. The mean intraocular pressure decreased from 29.7±9.6 mm Hg preoperatively to 14.6±6.5 mm Hg at 12 months postoperatively (P<0.001). Glaucoma medications were reduced from 4.2±0.9 at baseline to 1.9±1.3 at 12 months after TSCPC (P<0.001). A nonsignificant change of logarithm of the minimum angle of resolution visual acuity was observed at 12 months (P=0.722). The success rate at 12 months was 72.2%. No major complications were reported during the first year of follow-up. CONCLUSION Slow coagulation TSCPC had high efficacy and minimal complications when used as an initial glaucoma surgical procedure in patients with SO-induced glaucoma.
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Affiliation(s)
- Mohamed M. Khodeiry
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt
| | - Xiangxiang Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Beijing Eye Institute, Beijing Tongren Eye Center, Beijing Tongren Eye Hospital, Capital Medical University, Beijing, China
| | - Huda Sheheitli
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mohamed S. Sayed
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Richard K. Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
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Souissi S, Le Mer Y, Metge F, Portmann A, Baudouin C, Labbé A, Hamard P. An update on continuous-wave cyclophotocoagulation (CW-CPC) and micropulse transscleral laser treatment (MP-TLT) for adult and paediatric refractory glaucoma. Acta Ophthalmol 2021; 99:e621-e653. [PMID: 33222409 DOI: 10.1111/aos.14661] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/06/2020] [Accepted: 10/11/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Continuous-wave cyclophotocoagulation (CW-CPC) is often preferred to medical and surgical treatments for managing refractory glaucoma. This review summarizes diode CW-CPC indications, history, histopathology, methods, efficacy and safety. It also provides an overview of the latest data available on micropulse transscleral laser treatment (MP-TLT) that uses repetitive micropulses of diode laser energy in an off-and-on cyclical fashion. METHODS A literature review was conducted on transscleral CW-CPC (CW-TSCPC), endoscopic CPC (ECP) and MP-TLT. Relevant series of adult and paediatric patients were included for assessing the procedures. RESULTS Regarding CW-TCPC, highly variable success rates are reported in the literature, depending on the definition of success, type of underlying glaucoma, energy settings, follow-up duration and retreatment rates. CW-CPC often needs to be repeated, especially in paediatric patients. CW-CPC exposes to risks of inflammation and chronic ocular hypotony or phthisis with irreversible visual loss. CW-TSCPC has mainly been used in very severe forms of glaucoma, in painful eyes with limited visual potential or after filtering surgery failure. Published data on ECP are more limited but overall good success rates have been reported. Through the direct visualization of the targeted ciliary body in anatomically abnormal eyes, ECP is the preferred surgical procedure in paediatric refractory glaucoma. Complication rates are relatively low after ECP; however, large studies with long-term follow-up are needed. ECP may be used in difficult, refractory cases, but it is often used earlier when combined with cataract surgery. Despite limited data on the exact mechanism of action of MP-TLT and a lack of standardization of laser settings, the first data from heterogeneous case series shows that it has a similar efficacy and a better safety profile compared to CW-TSCPC in the medium term. CONCLUSION Although they may lead to sight-threatening complications, both CW-TSCPC and ECP seem effective. ECP appears to be superior to CW-TSCPC in paediatric refractory glaucoma. Unlike ECP combined with cataract surgery, evidence supporting a wider use of CW-TSCPC and MP-TLT in earlier stages of neuropathy is lacking. While it now appears that the safety profile of MP-TLT is superior to that of CW-CPC, robust prospective comparative studies including homogeneous and well-defined cohorts of patients are still needed to confirm an at least comparable efficacy in the long term.
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Affiliation(s)
- Soufiane Souissi
- Department of Vitreoretinal Surgery Adolphe de Rothschild Foundation Paris France
| | - Yannick Le Mer
- Department of Vitreoretinal Surgery Adolphe de Rothschild Foundation Paris France
| | - Florence Metge
- Department of Pediatric Ophthalmology Adolphe de Rothschild Foundation Paris France
| | - Alexandre Portmann
- Department of Pediatric Ophthalmology Adolphe de Rothschild Foundation Paris France
| | | | - Antoine Labbé
- Department of Ophthalmology III Quinze‐Vingts Hospital Paris France
| | - Pascale Hamard
- Department of Ophthalmology III Quinze‐Vingts Hospital Paris France
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Liebenthal R, Schuman JS. Transscleral cyclophotocoagulation in the treatment of glaucoma: patient selection and perspectives. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1951232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Departments of Biomedical Engineering and Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Center for Neural Science, NYU, New York, NY, USA
- Department of Physiology and Neuroscience, NYU Langone Health, New York, NY, USA
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Senthil S, Dada T, Das T, Kaushik S, Puthuran GV, Philip R, Rani PK, Rao H, Singla S, Vijaya L. Neovascular glaucoma - A review. Indian J Ophthalmol 2021; 69:525-534. [PMID: 33595466 PMCID: PMC7942095 DOI: 10.4103/ijo.ijo_1591_20] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neovascular glaucoma (NVG) is a sight-threatening secondary glaucoma characterized by appearance of new vessels over the iris and proliferation of fibrovascular tissue in the anterior chamber angle. Retinal ischemia is the common driving factor and common causes are central retinal vein occlusion, proliferative diabetic retinopathy, and ocular ischemic syndrome. The current rise in the prevalence of NVG is partly related to increase in people with diabetes. A high index of suspicion and a thorough anterior segment evaluation to identify the early new vessels on the iris surface or angle are essential for early diagnosis of NVG. With newer imaging modalities such as the optical coherence tomography angiography and newer treatment options such as the anti-vascular endothelial growth factor, it is possible to detect retinal ischemia early, tailor appropriate treatment, monitor disease progression, and treatment response. The management strategies are aimed at reducing the posterior segment ischemia, reduce the neovascular drive, and control the elevated intraocular pressure. This review summarizes the causes, pathogenesis, and differential diagnoses of NVG, and the management guidelines. We also propose a treatment algorithm of neovascular glaucoma.
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Affiliation(s)
- Sirisha Senthil
- VST Glaucoma Center, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Tanuj Dada
- Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Taraprasad Das
- Srimathi Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sushmita Kaushik
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Reni Philip
- Smt Jadhavabai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Padmaja Kumari Rani
- Srimathi Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Harsha Rao
- Narayana Nethralaya, Bangalore, Karnataka, India
| | - Shaveta Singla
- VST Glaucoma Center, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Lingam Vijaya
- Smt Jadhavabai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Abdullatif AM, Ahmed El-Saied HM. Various modalities of cyclodestruction in non-refractory glaucoma: a comparative study. Int Ophthalmol 2021; 41:3313-3323. [PMID: 34009517 DOI: 10.1007/s10792-021-01893-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the study is to study the safety and efficacy of three cyclodestructive treatments; high-intensity focused ultrasound (HIFU) cyclocoagulation versus micropulse cyclophotocoagulation (MP-CPC) versus transscleral continuous-wave cyclophotocoagulation (CW-CPC) for treatment of non-refractory glaucoma. METHODS This is a prospective comparative single-center study. Thirty non-refractory, medically uncontrolled, primary open-angle glaucoma patients with good vision were randomized to a single session of HIFU, MP-CPC or CW-CPC. Intraocular pressure (IOP) reduction, number of medications, success rate, visual acuity and complications were compared between the three groups. Success was defined as an IOP reduction of 30% and IOP between 6 and 21 mmHg with or without medications, in the absence of vision-threatening complications. RESULTS Thirty patients were enrolled in our study: 10 patients received HIFU, 10 patients received MP-CPC and 10 patients received CW-CPC. At 6 months, IOP was reduced by 31.5%, 23.9% and 19.4% (P = 0.4) achieving a success rate of 50%, 60% and 50% (P = 0.8) for continuous, micropulse and HFU groups, respectively, with reduction in the number of drops and stop of oral acetazolamide. Although the difference in the rate of complications between groups was not significant, CW-CPC group had more complications. CONCLUSIONS Cyclophotocoagulation could be an option in the treatment of non-refractory glaucoma even in patients with good visual acuity, with similar outcomes between the three types of cyclodestruction.
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Affiliation(s)
| | - Heba Magdy Ahmed El-Saied
- Department of Ophthalmology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt. .,, Giza, Egypt.
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27
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Lenzhofer M, Hohensinn M, Hitzl W, Steiner V, Motaabbed A, Motloch K, Colvin HP, Reitsamer HA, Moussa S. Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation. Graefes Arch Clin Exp Ophthalmol 2021; 259:2351-2361. [PMID: 33797631 PMCID: PMC8352832 DOI: 10.1007/s00417-021-05157-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population. Methods Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP. Results IOP reductions of −35, −39, −25, −25, −23, −34, and −36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12–0.38]), and the drop persisted during the following 12 months. Conclusion The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.
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Affiliation(s)
- Markus Lenzhofer
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria. .,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
| | - Melchior Hohensinn
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Veit Steiner
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Armin Motaabbed
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Karolina Motloch
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Hans Peter Colvin
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Herbert A Reitsamer
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Sarah Moussa
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
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Figus M, Sartini F, Covello G, Posarelli C. High-intensity focused ultrasound in the treatment of glaucoma: a narrative review. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1902309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michele Figus
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Francesco Sartini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Giuseppe Covello
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Posarelli
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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Micropulse trans-scleral laser therapy outcomes for uncontrolled glaucoma: a prospective 18-month study. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 56:371-378. [PMID: 33577756 DOI: 10.1016/j.jcjo.2021.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of micropulse trans-scleral laser therapy (mTLT) in glaucomatous patients. DESIGN Prospective, interventional study in a university hospital setting. PARTICIPANTS Fifty-two eyes of 52 adult patients with uncontrolled glaucoma despite maximal tolerated medical treatment, and/or poor candidates for filtering surgery. METHODS Participants received a 360-degree mTLT diode laser treatment (2000mW, 31.33% duty cycle), with duration adjusted to iris pigmentation and glaucoma severity (160-320 seconds). They were followed for 18 months to assess intraocular pressure (IOP), number of medications, corrected distance visual acuity (CDVA), glaucoma progression based on Humphrey Sita 24-2 perimetry and Cirrus high-definition optical coherence tomography, and complications. The primary outcome measure was the absolute success at 18 months. Absolute success was defined as an IOP 6-21 mm Hg and at least 25% IOP reduction, with equal or less number of IOP medications. Qualified success allowed for an increased number of IOP medications. Failure was defined as an inability to meet the criteria for success or the need for incisional glaucoma surgery. RESULTS Treatment absolute success was 61.5% at 12 months and 59.6% at 18 months. Mean IOP was reduced by 35.6% at 18 months (23.6 ± 6.5 mm Hg at baseline; 15.2 ± 4.1 mm Hg at 18 months, p < 0.001). mTLT did not significantly reduce the number of topical glaucoma medications (p = 0.075); however, 15 eyes (29%) had systemic oral glaucoma treatment at baseline and 10 eyes (20%) at 18 months. Eight patients (15%) experienced vision loss of ≥2 lines after the procedure. Three patients (6%) regained their preoperative CDVA by 1 month, and 3 patients (6%) by 3 months, while 2 patients (4%) sustained persistent visual loss. No ocular complications were noted in 84.6%. Incisional surgery was required in 25% of eyes owing to inadequately controlled glaucoma despite mTLT. CONCLUSIONS mTLT is a good therapeutic option for moderate IOP reduction, while being safe and predictable. This improved safety profile makes mTLT a treatment to be considered earlier in the management of glaucoma.
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Micropulse Trans-scleral Cyclophotocoagulation in Patients With Glaucoma: 1- and 2-Year Treatment Outcomes. J Glaucoma 2021; 29:794-798. [PMID: 32459690 DOI: 10.1097/ijg.0000000000001552] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PRéCIS:: Micropulse trans-scleral cyclophotocoagulation (TSCPC) is an effective and safe IOP-lowering treatment for patients with primary or secondary glaucoma. PURPOSE To investigate the 1-year and 2-year effect on intraocular pressure (IOP) and safety profile of micropulse TSCPC in patients with glaucoma. METHODS Patients with glaucoma underwent a standardized micropulse TSCPC (MicroPulse P3 probe, Iridex cyclo G6 laser system, Mountain View, CA) at the University Eye Clinic Maastricht from November 2016 to May 2018. Patients with at least 12 months of follow-up were included. RESULTS A total of 141 eyes of 136 patients were included. The mean age was 67.2±14.5 years, and 56.6% of patients were male individuals. The glaucoma subtypes treated were primary glaucoma (n=99) and secondary glaucoma (n=42). Prior glaucoma surgery was performed in 59 of 141 eyes (41.8%). The mean preoperative IOP was 23.5±9.4 mm Hg. The mean postoperative IOP dropped to 16.8±8.4, 17.0±7.8, and 16.8±9.2 mm Hg, after 12, 18, and 24 months, respectively. The mean number of IOP-lowering medications used preoperatively was 3.3±1.4. The mean number of medications used at 12, 18, and 24 months was respectively 2.6±1.5, 2.5±1.4, and 2.2±1.5. Postoperative complications included cystic macular edema (n=2), hypotony maculopathy (n=1), fibrinous/uveitic reaction (n=1), and rejection of corneal graft (n=1), all reversible after treatment. One patient developed persisting hypotony in the late postoperative period. CONCLUSIONS Micropulse TSCPC is a safe and effective treatment for lowering both IOP and the number of IOP-lowering medications. Micropulse TSCPC can also be considered as a good alternative treatment option for patients after failed incisional glaucoma surgery or patients who are at high risk for incisional surgery.
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Sheheitli H, Persad PJ, Feuer WJ, Sayed MS, Lee RK. Treatment Outcomes of Primary Transscleral Cyclophotocoagulation. Ophthalmol Glaucoma 2021; 4:472-481. [PMID: 33429109 DOI: 10.1016/j.ogla.2020.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To report treatment outcomes of primary transscleral cyclophotocoagulation (TSCPC) in glaucomatous eyes. DESIGN Retrospective noncomparative study. PARTICIPANTS Forty-eight eyes with a diagnosis of glaucoma and no previous incisional ocular surgery. METHODS Continuous-wave TSCPC was applied to the ciliary body. MAIN OUTCOME MEASURES The primary outcome measure was surgical success defined as an IOP ≤ 21 mmHg and reduced by 20% or more from baseline, IOP > 5 mmHg, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures included visual acuity (VA) and complications. RESULTS Glaucoma eyes were stratified into 2 groups: (1) those with pretreatment IOP >21 mmHg (high group) and (2) those with pretreatment IOP ≤ 21 mmHg (low group). Mean ± standard deviation (SD) IOP at baseline was 30.6 ± 6.3 mmHg in the high group and 16.2 ± 2.8 mmHg in the low group. Mean ± SD number of glaucoma medications at baseline was 4.1 ± 0.8 in the high group and 3.6 ± 1.1 in the low group. Based on our success criteria, the cumulative probability of success during the first year of follow-up was 58.3% in the high group and 28.1% in the low group (P = 0.052). Postoperative mean IOP was significantly lower than baseline IOP in the high group at 1-, 3-, 6-, 12-, and 18-month postoperative visits (P < 0.05). No significant change was observed in IOP at follow-up visits after 1 month in the low IOP group. Throughout the first year of follow-up, both groups required fewer glaucoma medications compared with baseline at the 1-, 3-, 6-, and 12-month postoperative visits (P < 0.05). The most frequent cause of postoperative decrease in VA was cataract in 9 eyes. Decrease in vision resulting from glaucoma was observed in 3 eyes. Complications included prolonged inflammation (11 eyes), iris neovascularization (2 eyes), cystoid macular edema (4 eyes), and hyphema (1 eye). No severe or long-term complications were observed. CONCLUSIONS Continuous-wave TSCPC was effective in lowering IOP in glaucoma patients without prior incisional ocular surgery whose disease was recalcitrant to medical therapy, particularly those with baseline IOP of more than 21 mmHg.
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Affiliation(s)
- Huda Sheheitli
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Patrice J Persad
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William J Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mohamed S Sayed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Richard K Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
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Vieira R, Marta A, Figueiredo A, Reis R, Sampaio I, Menéres MJ. Transscleral Cyclophotocoagulation in Familial Amyloidotic Polyneuropathy Secondary Glaucoma after Ahmed Valve Implantation: A Case Series Study. J Curr Glaucoma Pract 2021; 15:32-35. [PMID: 34393454 PMCID: PMC8322595 DOI: 10.5005/jp-journals-10078-1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the outcomes of transscleral cyclophotocoagulation (TSCPC) after Ahmed glaucoma valve (AGV) implantation failure in patients with familial amyloidotic polyneuropathy (FAP) secondary glaucoma. Materials and methods In this retrospective study, all patients with secondary FAP glaucoma who underwent AGV implantation between 2010 and 2019 in our tertiary center were assessed. Among all, those patients who needed TSCPC to control intraocular pressure (IOP) after AGV were selected. Demographic data, value of IOP, best-corrected visual acuity (BCVA), number of antiglaucomatous medications, surgical complications, and need for retreatment were collected. Results From a total of 124 eyes submitted to AGV implantation, 13 eyes (10.48%) needed TSCPC to control IOP. The median age at TSCPC was 49.50 years (43; 55.75), and the median period between AGV implantation and TSCPC was 1.63 years (1.00; 3.65). There was a significant decrease of IOP after the procedure, from 24.33 ± 4.76 to 11.33 ± 2.90 mm Hg at last visit (p < 0.001). A reduction in the number of antiglaucomatous medications was also noticed, from 3.92 ± 0.29 to 1.25 ± 1.42 (p < 0.001). There was no difference in BCVA (p = 0.502). After the procedure, there was an exuberant anterior chamber (AC) reaction in two eyes (16.7%), and one case developed a neurotrophic ulcer (8.3%). There was no need for re-treatment. Conclusion Ahmed glaucoma valve implantation is a promising surgical procedure to treat patients with PAF secondary glaucoma, showing good results. For refractory cases, TSCPC seems to be effective and safe to control IOP. Clinical significance There are only a few studies in current literature that address amyloid secondary glaucoma, maybe because it is a rare pathology worldwide. However, it has a high incidence in certain regions, including the north of Portugal. For the record, this is the first study describing the tool of cycloablative procedures in this type of glaucoma. How to cite this article Vieira R, Marta A, Figueiredo A, et al. Transscleral Cyclophotocoagulation in Familial Amyloidotic Polyneuropathy Secondary Glaucoma after Ahmed Valve Implantation: A Case Series Study. J Curr Glaucoma Pract 2021;15(1):32–35.
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Affiliation(s)
- Rita Vieira
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Ana Marta
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Ana Figueiredo
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Rita Reis
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Isabel Sampaio
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Maria J Menéres
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
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Abstract
Lasers have been in use as a treatment modality of glaucoma for more than last four decades. Each passing year has added newer dimensions to the existing laser technologies enhancing their safety and efficacy profile. This has become possible due to continuous research and innovations with proper understanding of the mechanism of action of different variety of lasers as treatment options. Each category of glaucoma has different underlying pathologies. Adequate knowledge and understanding of indications, limitations and hazards of these laser procedures are must before their application for improvising outcome. Recent years have witnessed a revolution this field. A thorough literature search was conducted in PubMed, Medline, the Cochrane Library Database, EMBASE, and Scopus and Google Scholar until May 2020 using the keywords, and all the articles pertaining to the relevant topics were included in this review. Purpose of this review is to summarize the important laser procedures currently in use for managing glaucoma along with updating the readers with recent advances in laser technologies, their extended applications and also analyzing possible future implications.
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Gavrilina PD, Gamidov AA, Baum OI, Bolshunov AV, Khomchik OV, Sobol EN. [Transscleral laser therapy in the treatment of glaucoma]. Vestn Oftalmol 2020; 136:113-120. [PMID: 33084288 DOI: 10.17116/oftalma2020136061113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nowadays glaucoma is one of the leading causes of irreversible blindness worldwide. The main goal in preservation of vision in glaucoma patients is reducing intraocular pressure (IOP), which is considered the main controlled risk factor for progression of glaucomatous optic neuropathy. The article discusses the effectiveness and safety of various transscleral laser technologies in the treatment of glaucoma. Modern transscleral laser technologies that affect the uveoscleral drainage and scleral hydro-permeability are less traumatic and more gentle making them promising in the treatment of patients with early stages of glaucoma, and not only in terminal glaucoma with pain syndrome resistant to conventional treatment ("last resort surgery").
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Affiliation(s)
- P D Gavrilina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A A Gamidov
- Research Institute of Eye Diseases, Moscow, Russia
| | - O I Baum
- Institute of Photon Technologies of the Federal Scientific Research Centre "Crystallography and Photonics", Troitsk, Russia
| | | | - O V Khomchik
- Research Institute of Eye Diseases, Moscow, Russia
| | - E N Sobol
- Institute of Photon Technologies of the Federal Scientific Research Centre "Crystallography and Photonics", Troitsk, Russia
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Anand N, Klug E, Nirappel A, Solá-Del Valle D. A Review of Cyclodestructive Procedures for the Treatment of Glaucoma. Semin Ophthalmol 2020; 35:261-275. [DOI: 10.1080/08820538.2020.1810711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nandita Anand
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Emma Klug
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Abraham Nirappel
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - David Solá-Del Valle
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Shukla AG, Ramulu PY. Management of Anticoagulation and Antiplatelet Therapy in Glaucoma Surgery. J Glaucoma 2020; 29:732-741. [PMID: 32858723 DOI: 10.1097/ijg.0000000000001594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of antithrombotic therapy is rising as the population of older adults grows and novel agents with wider indications emerge. Likewise, surgical treatment of glaucoma may become increasingly common as the prevalence of glaucoma increases and innovative treatment options are developed. These trends highlight the need to understand how best to manage antithrombotic therapy in the context of glaucoma surgery. This review article describes current literature on antithrombotic therapy and perioperative thromboembolic risk evaluation based on individual factors. In addition, guidance is offered on the management of antithrombotic therapy in the setting of each type of glaucoma surgery, with an emphasis on a multidisciplinary approach involving the patients' treating physicians.
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Affiliation(s)
- Aakriti G Shukla
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
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Outcome of Surgical Management of Glaucoma Following Complex Retinal Detachment Repair With Silicone Oil Tamponade: Drainage Implant Versus Cyclophotocoagulation. J Glaucoma 2020; 29:198-204. [PMID: 31913222 DOI: 10.1097/ijg.0000000000001435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRéCIS:: Glaucoma drainage devices (GDDs) are effective for the management of silicone oil-induced glaucoma. Although cyclophotocoagulation (CPC) has the advantage of shorter operative time and repeatability, it carries a higher risk of failure, blindness, and phthisis. BACKGROUND/AIMS To compare the surgical outcome of GDD implantation and diode laser CPC in the management of refractory glaucoma following vitrectomy with silicone oil (SO) injection. MATERIALS AND METHODS In total, 56 eyes with refractory glaucoma after SO tamponade that underwent either CPC or GDD implantation were retrospectively evaluated. All patients underwent a complete ophthalmic examination and intraocular pressure (IOP) measurement at baseline and 1 day, 1 week, 1, 3, 6, and 12 months postoperatively. The rates of complete success and qualified success (for IOP between ≥5 and ≤21 mm Hg) were analyzed. RESULTS A total of 17 eyes underwent GDD implantation and 39 eyes underwent CPC. The preoperative IOP was 35.7±7.9 mm Hg and 27.8±8.4 mm Hg for the CPC and GDD groups, respectively (P=0.001), with a worse baseline visual acuity (P=0.01) and a higher proportion of SO-filled eyes in the CPC group (P<0.01). The IOP at 1 year postoperatively was 23.5±11.5 mm Hg and 15.3±5.9 mm Hg for the CPC and GDD group, respectively (P=0.01). Both groups achieved a reduction in IOP and number of medications at 1 year (P<0.001). The success rate in the GDD group was 94.1% (16/17), and 53.8% (21/39) in the CPC group at 12 months (P<0.005). Five eyes and 1 eye lost light perception vision in the CPC and GDD groups, respectively. CONCLUSIONS GDD implantation may carry a higher surgical success rate than CPC. However, CPC retains the advantage of being technically easier and repeatable.
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Phacoemulsification Combined With Endoscopic Versus Transscleral Cyclophotocoagulation in Poorly Controlled Glaucoma: A Comparative Case Series. J Glaucoma 2020; 29:53-59. [PMID: 31693645 DOI: 10.1097/ijg.0000000000001403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to report medium-term outcomes of a novel combination of phacoemulsification with transscleral cyclophotocoagulation (phaco-TCP) compared with combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) in patients with uncontrolled or suboptimally controlled glaucoma and coexisting cataract. MATERIALS AND METHODS Retrospective case series of 80 consecutive patients with a minimum of 12 months of follow-up. In total, 46 eyes underwent phaco-ECP and 34 phaco-TCP. Success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with ≥20% reduction from preoperative IOP (with no increase in ocular hypotensive medications or further glaucoma surgery). Secondary outcomes were change in IOP, number of ocular hypotensive medications and safety. RESULTS The mean follow-up was 32.6 ±10.3 months. Preoperative clinical characteristics were similar in both groups. At latest follow-up, success rate was greater with phaco-TCP than phaco-ECP (67.6% and 47.8%, P=0.037). IOP was also significantly lower after phaco-TCP (14.88±5.57 mm Hg, from 22.62±6.52 mm Hg) than phaco-ECP (18.07±6.72 mm Hg, from 22.83±7.88, P=0.0273). Ocular hypotensive medications required reduced similarly after phaco-TCP (from 3.38±0.88 to 2.65±1.04 medications, P=0.0012) and phaco-ECP (from 3.07±0.929 to 2.63±1.42 medications, P=0.0108). There were no cases of hypotony or reduction in vision related to glaucoma with either surgical intervention and a similar proportion required further glaucoma surgery (phaco-ECP 15.2%, phako-TCP 5.9%, P=0.2884). CONCLUSIONS Phaco-TCP appears more successful in controlling IOP than phaco-ECP with similar safety. Further investigation is warranted of this newly proposed combination which may be particularly useful where access or experience with ECP or other minimally invasive glaucoma surgery is limited.
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Phaco-endocycloplasty versus Phacotrabeculectomy in Primary Angle-Closure Glaucoma: A Prospective Randomized Study. Ophthalmol Glaucoma 2020; 3:434-442. [PMID: 32771456 DOI: 10.1016/j.ogla.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the efficacy and safety of endocycloplasty (ECPL) versus trabeculectomy when it is combined with phacotrabeculectomy in medically controlled or uncontrolled primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI). DESIGN Prospective, interventional, randomized control trial. PARTICIPANTS Subjects with PAC/PACG aged 30 years or more after LPI with visually significant cataract. METHODS Subjects underwent computer-generated randomized sequence of either procedure, phaco-ECPL or phacotrabeculectomy, for standard indications of combined glaucoma and cataract surgery. MAIN OUTCOME MEASURES Primary outcome measure was intraocular pressure (IOP). Secondary outcome measures were best-corrected visual acuity (BCVA), number of antiglaucoma medications (AGMs), complications, and failure. RESULTS A total of 45 eyes of 39 subjects were included. A total of 25 eyes underwent phaco-ECPL, and 20 eyes underwent phacotrabeculectomy. Five eyes in the phaco-ECPL group were excluded; 2 were excluded because laser was not delivered per protocol, and the rest had less than 3 months of follow-up. Mean follow-up was 16.25±8.1 months in the phaco-ECPL group and 18.9±9.5 months in the phacotrabeculectomy group. Mean preoperative and postoperative IOP, AGM, and BCVA did not differ between the groups. However, the rate of complications (P = 0.011) and interventions (P = 0.047) was greater in the phacotrabeculectomy group. CONCLUSIONS Both procedures are efficacious in lowering IOP in PACG, but the rate of complication and interventions for these were more in the phacotrabeculectomy group. Longer follow-up is indicated to probe the feasibility of phaco-ECPL, a minimally invasive procedure, as first-step management in PAC disease, for which combined cataract and glaucoma surgery is indicated.
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Maslin JS, Chen PP, Sinard J, Nguyen AT, Noecker R. Histopathologic changes in cadaver eyes after MicroPulse and continuous wave transscleral cyclophotocoagulation. Can J Ophthalmol 2020; 55:330-335. [PMID: 32446502 DOI: 10.1016/j.jcjo.2020.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the acute histological effects of MicroPulse transscleral cyclophotocoagulation (MPCPC) using the MicroPulse P3 Device and continuous wave transscleral cyclophotocoagulation (CWCPC) on the ciliary body and adjacent structures in human cadaver eyes. METHODS Quadrants of 6 human cadaver eyes from 3 different donors were subjected to traditional CWCPC, slow burn CWCPC, MPCPC, or no treatment (internal control). Sutures were used to differentiate different treatment areas on each eye. Differential inking was applied after treatments to aid in microscopic correlation. All specimens were subject to standard histologic processing. Tissue sections were cut at 4 microns and stained with hematoxylin and eosin according to established protocols. Pathologic evaluation by light microscopy was confirmed by a senior pathologist blinded to treatment groups. RESULTS In all 6 eyes, tissues treated with traditional and low burn CWCPC showed variable coagulative tissue damage to the ciliary body compared with untreated tissues. Minimal histologic changes were identified within the ciliary processes, although variable pigment clumping and streaming were noted within the pigmented ciliary epithelium. In contrast to CWCPC, MPCPC-treated tissues showed only minimal coagulative tissue damage to the ciliary body. Variable pigment clumping and streaming, however, were also noted in the pigmented ciliary epithelium in MPCPC-treated tissues. CONCLUSIONS In human cadaver eyes, MPCPC treatment caused less tissue disruption to the ciliary body compared with traditional and low burn CWCPC treatments. MPCPC may be a less destructive and more selective method of cyclophotocoagulation when compared with traditional and low burn CWCPC.
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Affiliation(s)
- Jessica S Maslin
- University of Southern California Roski Eye Institute, Los Angeles, CA
| | - Peter P Chen
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - John Sinard
- Department of Pathology, Yale University School of Medicine, New Haven, CT; Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT
| | - Alexander T Nguyen
- Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT..
| | - Robert Noecker
- Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT
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Lanzagorta-Aresti A, Montolío-Marzo S, Davó-Cabrera JM, Piá-Ludeña JV. Transscleral versus endoscopic cyclophotocoagulation outcomes for refractory glaucoma. Eur J Ophthalmol 2020; 31:1107-1112. [PMID: 32228024 DOI: 10.1177/1120672120914230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Grohmann C, Farrokhi S, Klemm M. [Efficiency and Therapy Safety of Fractionated Cyclophotocoagulation with up to Ten Laser Spots for Advanced Primary Open-Angle and Pseudoexfoliation Glaucoma]. Klin Monbl Augenheilkd 2020; 238:598-602. [PMID: 32016940 DOI: 10.1055/a-1057-9699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Various procedures are available for the treatment of advanced glaucoma. We examined the efficacy and safety of fractionated cyclophotocoagulation (CPC) with up to ten laser spots for advanced primary open-angle glaucoma (POAG) and pseudoexfoliation (PEX) glaucoma treated with maximal topical therapy or eye-drop intolerance. MATERIAL UND METHODS This retrospective study evaluated data from 297 eyes with advanced POAG and PEX glaucoma which received 10 applications of CPC between February 2012 and June 2017. Intraocular pressure (IOP), number of topical eye drops and postoperative complications were evaluated. Data were collected preoperatively, four weeks postoperatively, and at the last documented contact (six months postoperative visit). The paired Wilcoxon rank sum test was used to analyse the changes. RESULTS The IOP for open-angle glaucoma decreased from 16.66 ± 4.36 mmHg preoperatively to 13.87 ± 3.59 mmHg at the last visit (6 months postoperative visit; p < 0.05). The IOP for the PEX glaucoma decreased significantly from 20.76 ± 9.55 mmHg preoperatively to 15.50 ± 5.93 mmHg at the last visit (p < 0.003). The number of hypotensive agents in the POAG was 2.51 ± 1.00 preoperatively and at the last visit 2.27 ± 1.03. In PEX glaucoma, the number of hypotensive agents was 2.46 ± 1.07 preoperatively and at the last visit 1.88 ± 0.97. Treatment-related complications occurred in three eyes - two cases of postoperative macular oedema, which were treated well with systemic steroids, and one case of pretreated anterior chamber irritation with hyphema, which was also treated with topical steroids. CONCLUSION In our group of patients, the mild CPC performed by us with a maximum of 10 applications (vs. the conventional 20 - 30 applications) produced a good reduction of intraocular pressure, as well as a reduction in topical medication, with a low complication rate.
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Affiliation(s)
- Carsten Grohmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - Sanaz Farrokhi
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - Maren Klemm
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf
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Mohamed NG, Yap TE, Almonte M, Susanna FN, Crawley L, Cordeiro MF. Focusing on surgical and laser advances in glaucoma management. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1724538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nada G. Mohamed
- The Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Timothy E. Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Melanie Almonte
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Fernanda N. Susanna
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
- Department of Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Laura Crawley
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Maria Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
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Transscleral cyclophotocoagulation and its histological effects on the conjunctiva. Sci Rep 2019; 9:18703. [PMID: 31822709 PMCID: PMC6904490 DOI: 10.1038/s41598-019-55102-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022] Open
Abstract
Micropulse transscleral cyclophotocoagulation (MP-TCP) is increasingly being used as an initial procedure prior to conjunctival filtration surgeries. However, it is uncertain whether MP-TCP may cause inflammation and scarring of the bulbar conjunctiva. Thus, we aimed to study the histological effects of MP-TCP (compared to controls and continuous wave [CW]-TCP) on the conjunctiva. Our study included 10 Dutch Belted Rabbits that underwent TCP in their right eyes (n = 5, MP-TCP; n = 5, CW-TCP), while their left eyes served as controls. The rabbits were euthanised at 4 weeks, and their dissected globes underwent histopathological and immunohistochemical examination. We observed greater conjunctival inflammation in MP-TCP or CW-TCP-treated eyes compared to controls, but not between each other. The majority of the lymphocytic infiltrates were CD4 T-cells. Increased conjunctival fibrosis was evident in MP-TCP or CW-TCP-treated eyes, to similar extents, compared to controls. However, the increased staining for myofibroblasts was not statistically significant in TCP-treated eyes. We concluded that MP-TCP causes significantly greater overall conjunctival inflammation and scarring compared to controls, similar to CW-TCP. As these are risk-factors for fibrosis and failure of the conjunctival bleb, further studies are required to explore the effect, if any, of post-TCP conjunctival changes on future bleb morphology and survival.
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Paul C, Kaus S, Müller HH, Schröder FM, Sekundo W. Trabeculectomy offers better intraocular pressure reduction in intrapatient comparison to transscleral cyclophotocoagulation. Graefes Arch Clin Exp Ophthalmol 2019; 257:2481-2487. [PMID: 31485731 DOI: 10.1007/s00417-019-04450-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Both trabeculotomy (TE) as well as transscleral endodiode laser cyclophotocoagulation (CPC) are common approaches in glaucoma surgery. The purpose of this study was to perform an intraindividual comparison of these procedures carried out by the same surgeon in the same patient on the same day. METHODS An observational monocentric retrospective cohort study was conducted. Patients with a bilateral refractory open-angle glaucoma who underwent trabeculectomy in one eye and transscleral endodiode laser cyclophotocoagulation in the fellow eye simultaneously were included and followed up with over the course of 1 year. RESULTS Eighty-two eyes of 41 patients were included. Seventeen patients (41.5%) were men and 24 (58.5%) women. The mean age was 68.7 ± 9.5 years. The diagnosis comprised 33 (80.5%) patients with a primary open-angle glaucoma, five (12.2%) patients with pseudoexfoliation glaucoma, and three (7.3%) patients with pigment dispersion glaucoma. A reduction in intraocular pressure (IOP) was seen in both after TE (from 26.2 ± 13.2 to 10.6 ± 4.1 mmHg, 52 weeks post-treatment) as well as CPC (from 24.2 ± 9.9 to 15.0 ± 5.4 mmHg, 52 weeks post-treatment). In comparison to each other, TE was significantly more effective in lowering the IOP (10.6 ± 4.1 vs. 13.4 ± 5.0; p = 0.0030, 52 weeks post-treatment) and needed antiglaucomatous medications (0.45 ± 0.80 vs. 1.24 ± 1.13; p = 0.0009, 52 weeks post-treatment). Consistently, the achievement rate of an IOP ≤ 16 mmHg without antiglaucomatous medications was significantly higher in TE-treated eyes (65.8% vs. 31.6%; p = 0.0019). Re-interventions, including 10 secondary TEs, were commonly required in those eyes undergoing CPC, especially in younger patients. CONCLUSIONS Trabeculectomy was demonstrated to be more effective in reducing IOP in comparison to fellow eyes receiving CPC. In particular, in younger patients, an additional TE in the CPC-treated eyes was necessary. The outcome of those secondary TEs however was comparable to the primarily performed TEs. Our study thus supports the use of CPC as tool to control IOP, especially in the context of bilateral refractive glaucoma.
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Affiliation(s)
- Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - Sonja Kaus
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany
| | - Hans-Helge Müller
- Institute of Medical Bioinformatics and Statistics, Philipps-University Marburg, Marburg, Germany
| | - Frank Michael Schröder
- Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Walter Sekundo
- Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
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Fong YYY, Wong BKT, Li FCH, Young AL. A Retrospective Study of Transcleral Cyclophotocoagulation Using the Slow Coagulation Technique for the Treatment of Refractory Glaucoma. Semin Ophthalmol 2019; 34:398-402. [DOI: 10.1080/08820538.2019.1638946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yoly Yeuk Ying Fong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Billy Kwok Tung Wong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Felix Chi Hong Li
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Alvin Lerrmann Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Ma A, Yu SW, Wong JK. Micropulse laser for the treatment of glaucoma: A literature review. Surv Ophthalmol 2019; 64:486-497. [DOI: 10.1016/j.survophthal.2019.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/12/2018] [Accepted: 01/04/2019] [Indexed: 11/15/2022]
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49
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Nguyen AT, Maslin J, Noecker RJ. Early results of micropulse transscleral cyclophotocoagulation for the treatment of glaucoma. Eur J Ophthalmol 2019; 30:700-705. [PMID: 30938190 DOI: 10.1177/1120672119839303] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe our clinical experience with the efficacy and safety of micropulse transscleral cyclophotocoagulation as a treatment for glaucoma. METHODS In this retrospective case series, we reviewed the charts of 95 consecutive patients with various glaucoma subtypes who underwent micropulse transscleral cyclophotocoagulation. Patients were offered micropulse transscleral cyclophotocoagulation if they had perimetric glaucoma refractory to intraocular pressure-lowering topical medications and who were poor candidates for traditional filtering surgery. Eligible patients were treated with the Micropulse P3 device (IQ 810 Laser Systems; Iridex, Mountain View, CA, USA) at 2.0-2.5 W for a duration of 90 s per hemisphere at a 31.3% duty cycle. If a retreatment was needed, the power was increased to up to 3.0 W with other parameters remaining the same. Patients were considered successfully treated if their intraocular pressure was lowered by at least 20% compared to their baseline. The main outcome measure was post-operative intraocular pressure; secondary outcome measures included the number of adverse events and complications that occurred with treatment. RESULTS The glaucoma subtypes treated included primary open-angle glaucoma (n = 51), exfoliation glaucoma (n = 24), chronic angle-closure glaucoma (n = 15), and congenital/juvenile glaucoma (n = 5). The mean pre-operative intraocular pressure was 25.1 ± 5.3 mm Hg and the mean post-operative intraocular pressure at 12 months was 17.5 ± 5.1 mm Hg (p = 0.004). The mean number of intraocular pressure-lowering medications used preoperatively was 3.0 ± 1.1; the mean number of medications used at the 12-month post-operative visit was 1.4 ± 1.0 (p = 0.03). Success with one treatment was achieved in 73 (76.8%) of patients. With multiple treatments, all patients had significant intraocular pressure-lowering compared to baseline. The maximum number of treatments received by any single patient was 5. There were no instances of prolonged intraocular inflammation or long-term hypotony. CONCLUSION Micropulse transscleral cyclophotocoagulation appears to be a safe and efficacious treatment for glaucoma. Given its improved safety profile compared to continuous-wave transscleral cyclophotocoagulation, it deserves consideration as a primary procedure.
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Affiliation(s)
- Alexander T Nguyen
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Jessica Maslin
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Robert J Noecker
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA.,Ophthalmic Consultants of Connecticut, Fairfield, CT, USA
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Benefits of SubCyclo Laser Therapy Guided by High-frequency Ultrasound Biomicroscopy in Patients With Refractory Glaucoma. J Glaucoma 2019; 28:535-539. [PMID: 30855414 DOI: 10.1097/ijg.0000000000001230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and safety of subliminal cyclophotocoagulation using a 25% duty cycle diode laser (Supra 810, SubCyclo, Quantel Medical). METHODS This was a pilot study of patients who underwent a SubCyclo photocoagulation procedure with a 25% duty cycle, between April 2016 and April 2017 at the Glaucoma Institute of Saint Joseph Hospital of Paris. All patients presented with an evolving moderate to severe glaucoma that were resistant to previous surgical treatments or with a contraindication for filtration surgery. Laser settings were programmed as follows: power 2000 mW, "on" time 0.63 ms, "off" time 1.9 ms, and 25% duty cycle per 100 seconds to each eye. RESULTS A total of 44 eyes of 34 patients were treated with subliminal cyclophotocoagulation, with a mean follow-up time of 12 months. Surgical success was defined as IOP ranging 6 to 21 mm Hg or a 20% IOP reduction at the last 12 months follow-up visit. The mean age of patients was 63.83±16.2 years. The mean preoperative IOP was 32.8±11.8 mm Hg which then decreased postoperatively to 24.02±7.03 mm Hg after 1 day, 18.34±8.31 mm Hg after 1 week, 18.26±8.53 mm Hg after 1 month, 20.5±8.53 mm Hg after 3 months, 18.9±9.2 mm Hg after 6 months and 18.8±9.3 mm Hg after 12 months. Our preliminary study using Subcyclo transscleral cyclophotocoagulation with a 25% duty cycle showed a 37% IOP reduction from the baseline after 3 months with a single laser session and a 45% reduction at the last 12 months follow-up, after more than one laser session. The mean number of ocular antihypertensive medications used was 3.4±1.7 before treatment which decreased to 3.0±1.6 after treatment. No significant complications or anatomic modifications were found after subliminal cyclophotocoagulation. CONCLUSIONS Subliminal cyclophotocoagulation with a 25% duty cycle is a safe and effective procedure for reducing IOP in cases of refractory glaucoma and seems to be safer than conventional transscleral cyclophotocoagulation.
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