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Brian McMillan, Tony Realini, Kenneth Mitchell; Ab interno cyclodialysis: Retrospective safety and efficacy outcomes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2701. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
We performed a retrospective, observational clinical study to determine the safety and efficacy of ab interno cyclodialysis as a conjunctival sparing method of intraocular pressure reduction in eyes with glaucoma.
29 consecutive patients aged 18 years or older who underwent ab interno cyclodialysis for treatment of various glaucomas (POAG:[N=18],NVG[N=5], Uveitic [N=2],chronic ACG [N=1], Pigmentary[N=1], NTG[N=1], Sturge-Weber ) were followed for up to 12 months. The primary outcome measure was IOP reduction from baseline with secondary endpoints: success/failure, number of glaucoma medications and effect on visual acuity. Absolute success was defined as a percent IOP reduction from baseline of 15% or greater on no medications, and qualified success requiring the addition of medications. Success/failure was based on IOP alone.
Of 29 subjects, 6 failed before 1 year and 7 were lost to follow-up.<br /> Mean pre-op IOP mmHg (25.38 +/- 8.20) was statistically significantly reduced at 1 wk 16.95 +/- 10.87(p=0.002), 1 mon 18.58 +/- 11.60 (p=0.025), 3 mon 16.95 +/- 8.43 (p=0.003), 6 mon 17.75 +/- 9.07(p=0.036) and 12 mon 17.13 +/- 9.48(p=0.036).<br /> Success at 12 months among those not lost to follow-up was 55% (12/22). The avg pre-op glaucoma drops 2.79 +/-0.77 increased with the addition of pilocarpine at 1 day 3.18 +/- 1.06 and 1wk 2.96+/-1.57, and decreased at 1mon 1.84+/-1.55, 3mon 1.87+/-1.51, 6mon 1.94+/-1.58, 12 mon 2.00+/-1.61.<br /> An avg of 4.6 +/- 3.76 lines of vision were lost at day 1, returning to baseline at 1 +/- 1.59 mon. 4 patients did not return to baseline (2 absolute success, 1 qualified, 1 failure).<br /> Hyphema was the most common complication seen in 83% at day 1 and typically resolved by 1 month. Additional complications included vitreous prolapse, hypotony maculopathy, hyphema requiring alteplase, phacodonesis, PCIOL dislocation, cataract.
Ab interno cyclodialysis may represent an effective means of lowering intraocular pressure while offering an alternative to more traditional procedures which result in conjunctival scarring. The procedure can result in significant complications and future studies will be needed to better describe the optimal indications for clinical use.
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