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Michael J. Dieckhaus, Pengcheng Lu, Karen M. Joos; Cyclophotocoagulation After Glaucoma Implant for Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2613.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate effectiveness of diode laser transscleral cyclophotocoagulation (TCP) after aqueous tube shunt placement in refractory glaucoma.
A retrospective review was performed of charts of adult patients who elected adjunctive TCP after shunt surgery by a single surgeon (KMJ) between January 1, 1998 and December 30, 2009 and had at least 12 months of follow-up. Information gathered included age, time after shunt placement, follow-up duration after TCP, best corrected visual acuity, intraocular pressures (IOPs), number of glaucoma medications, complications, and requirement of additional glaucoma surgery. Success was defined as an IOP < 21 and > 5 mmHg with or without medications.
32 patients who met criteria were identified. Mean age at time of TCP was 58.9+18.6 (SD) years. Average follow-up time after TCP was 46.8+27.8 months. Mean time between placement of the original implant and TCP was 31.8+33.6 months. There was no statistical difference between preoperative and 12 month (P=0.61) or final visit (P=0.12) visual acuity. Mean pre-operative IOP was 24.7+8.9 mmHg on a mean of 3.0+1.0 medications. At 6 months, IOP was 13.4+4.2 mmHg (P<0.001) on 2.2+1.0 medications (P<0.001). At 12 months, IOP was 13.7+3.3 mmHg (P<0.001) on 2.3+0.9 medications (P<0.001). At 24 months, IOP was 15.4+3.7 mmHg (P<0.001) on 2.3+1.1 medications (P=0.001). At 36 months, IOP was 15.1+4.3 mmHg (P<0.001) on 2.1+1.4 medications (P=0.006). At the final visit, IOP was 13.3+4.1 mmHg (P<0.001) on 2.0+1.1 medications (P=0.006). Three patients (9.3%) required corneal transplants. There were no instances of sympathetic ophthalmia, prolonged hypotony, or endophthalmitis. 31.3% required additional glaucoma procedures over the entire follow-up (28.1% underwent a second TCP while 15.6% underwent a second shunt). Success rates were 93.8% at 12 months, 85.2% at 24 months, and 80.2% at 36 months.
TCP is quicker to perform, less expensive and requires fewer post-operative restrictions and follow-up than implant surgery. Our data support TCP after initial tube shunt placement in patients with refractory glaucoma as an option to a second shunt. IOP and the number of glaucoma medications were both statistically reduced following TCP.
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