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Andrew Toren, Mathieu Carriere; Modified settings for transcleral cyclophotocoagulation of the ciliary body in glaucoma treatment. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6475.
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© ARVO (1962-2015); The Authors (2016-present)
Transcleral cyclophotocoagulation (TSCPC) of the ciliary body with a diode laser is an effective treatment for raised intra-ocular pressure (IOP) but its use is limited by the potential complications. Laser parameters are traditionally titrated until the presence of “pops” with a power of 2000mW for 2 seconds. The main objective of our study is to demonstrate the efficacy and complication rate of a lower intensity power of 1.25W for 4 seconds.
A retrospective cohort study was conducted for all patients with refractory glaucoma on maximum tolerated medical therapy who were treated with TSCPC using 1.25W for 4 seconds were identified. Intraocular pressure, vision, and complication data were collected during follow-up.
Forty-five patients were included in our study. The principal causes of elevated IOP were neovascular glaucoma (40%), open angle glaucoma (24%) and secondary glaucoma (16%). The mean age was 72.3±16.9 years and the mean time to follow up was 194.0±131.1 days (range: 13 to 606). Laser retreatments occurred in 10 eyes on average 113.9±124.3 days (range: 6 to 424) after the initial treatment. The initial mean IOP of 29.6±11.0mmHg decreased to 15.1±8.8mmHg (p<0.001) at last visit. After the first month, the mean IOP decreased to 16.0±9.2mmHg (p<0.001). The reduction was maintained during the 6th and 12th month with a mean IOP of 15.5±9.0 (p<0.001) and 13.2±6.5mmHg (p<0.01) respectively. In patients without retreatment, the mean IOP after the 1st, 6th and 9th months was 16.5±9.8, 16.6±9.9 and 12.0±4.5 mmHg respectively. Topical glaucoma medications decreased from an initial mean of 2.8±1.2 to a mean of 1.4±1.2 (p<0.001) at the last visit. Oral glaucoma medications decreased from an initial mean of 0.78±1.5 (0 to 6) to a mean of 0.20±0.84 (0 to 4) (p<0.01). Complications included uveitis, superficial conjunctival burns, hypotony, corneal edema, corneal erosion, cataract, pupillary mydriasis and retrobulbar hemorrhage. Visual acuity improved in 3 eyes and decreased in 8 eyes during follow up.
The new TSCPC settings demonstrate a short and medium term efficacy, a significant reduction in glaucoma medications, and limited significant side effects. Using modified parameters, TSCPC using a diode laser may have less complications and equal efficacy to traditional parameters. Further research needs to clarify the optimal paradigm for TSCPC treatment parameters.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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