Abstract
Purpose: :
To compare the changes in intraocular pressure (IOP) and visual outcomes of transcleral cyclophotocoagulation (TSCPC) between different types of glaucoma
Methods: :
A retrospective chart review was performed for patients who have undergone transcleral cyclophotocoagulation from September 1995 to August 2007. Patients were grouped by their specific diagnosis or type of glaucoma. Six main groups were analyzed: open angle glaucoma (OAG; n = 41), Post keratoplasty glaucoma (PK; n = 14), neovascular glaucoma (NVG; n = 13), infantile glaucoma (INF; n = 7), uveitic glaucoma (UV; n = 6), and glaucoma associated with congenital cataracts (CAT; n = 6). 87 eyes of 80 patients were analyzed, with follow up from 4 to 143 months (mean 34 months +/- 29.6 months) after initial TSCPC. Main outcome measures were changes in intraocular pressure and Snellen visual acuity before and after TSCPC at the final follow up visit. Treatment success was defined as IOP > 5 mm Hg and < 22 mm Hg.
Results: :
Mean pre-TSCPC IOP was as follows: OAG 29.5 mm Hg +/- 13.1; PK 35 mm Hg +/- 10.2; NVG 43 mm Hg +/- 15.3; INF 39.9 mm Hg +/- 11.8; UV 32.3 mm Hg +/- 12.3; CAT 33.6 mm Hg +/- 7.0. Mean post-TSCPC IOP was as follows: OAG 16.8 mm Hg +/- 7.2; PK 21.0 mm Hg +/- 16.9; NVG 14.5 mm Hg +/- 12.1; INF 23.7 mm Hg +/- 9.8; CAT 13.7 mm Hg +/- 5.2. There was no statistically significant difference in intraocular pressure change between the different groups, with the exception that there was a greater reduction of IOP in NVG group (-32.6 mm Hg) than in OAG group (-10.8 mm Hg) (p < 0.005). Furthermore there was not a significant difference in change in Snellen visual acuity between the different groups, with all groups having a change of approximately 1 line or less. Treatment success rates defined as IOP > 5 mm Hg and < 22 mm Hg were as follows: OAG 75.6%, PK 78.6%, NVG 35.7%, INF 42.9%, UV 100%, CAT 100%. Complications, other than decreased vision, included hypotony, hyphema, corneal decompensation, and corneal ulcer. The complications rates for each group were as follows: OAG 4.9%, PK 14.3%, NVG 28.6%, INF 28.6%, UV 0%, CAT 0%.
Conclusions: :
Transcleral cyclophotocoagulation is an effective means of lowering intraocular pressure in different types of glaucoma. This study showed that TSCPC reduced IOP in NVG to a greater extent than in OAG. However, this difference was likely due the increased rate of hypotony in the NVG group. Furthermore, there was a higher rate of complications in the NVG, INF, and PK groups.
Keywords: laser • ciliary body