Diode laser transscleral cyclophotocoagulation for the treatment of glaucoma in East Africa

[Glaucoma treatment by transscleral cyclophotocoagulation in micropulse technology in a low-income setting]

BACKGROUND

Glaucoma is the leading cause of irreversible blindness worldwide. The prevalence of glaucoma is particularly high in rural regions of Tanzania. Poverty and an inadequate ophthalmic infrastructure increase the difficulty of glaucoma treatment.

OBJECTIVE

Due to the limited access to eye drops or surgical therapy, the effectiveness of transscleral cyclophotocoagulation in micropulse technology (CPC-M) in advanced glaucoma was investigated in the present study.

MATERIALS AND METHODS

We included n = 50 eyes of 35 adult patients with advanced glaucoma and a glaucoma-typical papillary excavation with cupdisc ratio (CDR) ≥ 0.9, regardless of the glaucoma entity. The mean intraocular pressure (IOP) prior to treatment was 34 mm Hg (± 14 mm Hg). The operation was performed under retrobulbar anesthesia with the A.R.C. FOX 810 diode laser (A.R.C. Laser, Nuremberg, Germany; mean energy 127 J ± 10 J).

RESULTS

An IOP between 6 and 21 mm Hg or an IOP reduction by at least 20% of the initial value was defined as success. The success criteria were met by 71% of reevaluated eyes (n = 21) 3 months after treatment, and mean IOP was 19 mm Hg (± 13 mm Hg). Mean IOP 9 months postoperatively (n = 20) was 18 mm Hg (± 10 mm Hg) and the success criteria were met in 65% of cases. Seven eyes did not meet the success criteria: six eyes had a further increase in IOP and one eye showed intraocular hypotension.

CONCLUSION

The CPC‑M represents a good, inexpensive, and easily accessible treatment option for advanced glaucoma in order to reduce the likelihood of blindness in a low-income setting.

Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria

Importance

To investigate the safety, effectiveness and follow‐up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria.

Background

There is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance of surgery are poor.

Design

Prospective case series.

Participants

New glaucoma patients where surgical intervention was recommended.

Methods

A diode 810 nm laser G‐probe was used under retrobulbar anaesthesia to deliver approximately 20 shots for 2000 ms, titrating the power. If both eyes were treated the first was the study eye. Repeat treatment offered if the intraocular pressure (IOP) was >21 mmHg on two consecutive visits.

Main Outcome Measures

IOP < 22 mmHg, change in ≥2 lines of Snellen visual acuity (VA), and complications.

Results

201 out of 204 eyes with complete data analysed. Mean age 52 years, 17 (8.3%) eyes were re‐treated. Mean pre‐treatment IOP was 39 (SD 11) mmHg. 106 (53%) attended at 12 months when the mean IOP was 19 (7–45) mmHg; 77 (73%) had IOP < 22 mmHg. VAs were better in 13 (12.3%) and worse in 23 (21.7%) eyes. Postoperative complications included mild uveitis (5.5%), corneal oedema (2.5%), severe uveitis (0.5%) and transient hypotony (2.0%). No hypotony at 12 months.

Conclusions and Relevance

Transscleral diode laser cyclophotocoagulation controlled IOP in almost three quarters of eyes at 12 months with short‐term preservation of vision and minimal complications. Poor follow‐up in this setting highlights the need for an effective, safe and acceptable treatment where regular follow‐up is less critical.