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Caroline W Vargason, Karen M Joos; Long-term outcomes of transscleral cyclophotocoagulation after aqueous shunt placement for refractory glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6126.
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To evaluate effectiveness of diode laser transscleral cyclophotocoagulation (TSCPC) for refractory glaucoma after aqueous tube shunt placement.
IRB-approved retrospective chart review was performed of adults electing adjunctive TSCPC after shunt surgery by a single surgeon (KMJ) from 1/1/1998 to 12/31/2013 with at least 1 year of follow-up. Information gathered included age, time after shunt placement, follow-up duration after TSCPC, calculated logMAR visual acuities, intraocular pressure (IOP), ocular hypotensive medications, complications, and additional glaucoma surgeries. Data were analyzed at 1, 5, and 8 years post-operatively and at the final visit. Success was defined as an IOP of 6 to 21 mmHg with or without medications, and without additional glaucoma surgery, no light perception vision, or phthisis. Success was evaluated by single group Kaplan-Meier survival analysis.
49 eyes of 49 patients met inclusion criteria. Average age was 63.0±17.8 (mean±SD) years. Mean follow-up after TSCPC was 57.0±34.2 months. Time between implant placement and TSCPC was 40.6±38.9 months. Pre-operative and 1 year visual acuities were not statistically different (p=0.29, n=49). Pre-operative IOP was 23.8±7.8 mmHg on 3.1±1.0 medications. IOP was 14.4±3.45 mmHg (p<0.0001) on 2.5±1.0 medications (p<0.0001) at 1 year, 13.3±3.0 mmHg (p<0.0001) on 2.7±1.4 medications (p=0.43) at 5 years, and 12.4±2.2 mmHg (p=0.0001) on 2.7±1.4 medications (p=0.40) at 8 years. At the final visit, which was 57.0±34.2 months, IOP was 13.9±3.9 mmHg (p<0.0001) on 2.6±1.2 medications (p=0.021). 8.1% (n=4) required corneal transplants for edema. There were no instances of sympathetic ophthalmia, prolonged hypotony, or endophthalmitis. 30.6% (n=15) required additional glaucoma procedures over their follow-up: additional TSCPC (22.4%, n=11), second shunt (4.1%, n=2), or both TSCPC and shunt (4.1%, n=2). Success rate was 83.3% (95% CI 69.4-91.2) at 1 year (n=49), and Kaplan-Meier median survivial time was 84±7.4 (SE, 95% CI 69-99) months.
TSCPC is faster, less costly, and requires fewer post-operative restrictions and follow-up than implant surgery. IOP was significantly reduced at 1 and 8 years after TSCPC. Our data support TSCPC as a safe and effective adjunctive IOP lowering therapy for patients with refractory glaucoma after initial tube shunt placement.
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