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David Tabibian, Nicholas K Wride, Francisco C Figueiredo; Long-term intraocular pressure control and corneal graft survival in eyes treated with trans-scleral cyclodiode laser for refractory glaucoma after penetrating keratoplasty. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4779.
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© ARVO (1962-2015); The Authors (2016-present)
Refractory glaucoma is a frequent complication after penetrating keratoplasty (PKP) but controversy exists regarding its management which includes trabeculectomy, glaucoma drainage device (GDD) or trans-scleral cyclodiode laser (TC). We report here the long-term outcomes of intraocular pressure (IOP) control and corneal graft survival after TC treatment.
Retrospective observational clinical study including patients treated with TC for refractory glaucoma following PKP. Data were gathered in a tertiary corneal transplantation service database between 1995 and 2016. The patients were all treated with a similar 180° treatment protocol performed by the same surgical team. Outcome measures: IOP control, number of glaucoma medications, PKP survival.
Twenty-four eyes, of 24 patients (males=15) were identified. Mean age of patient at first TC treatment was 66 (SD 19 years) and mean interval between PKP and first TC was 34.16 (SD 55 months). The mean pre-treatment IOP was 29.75 mmHg (SD 8.02mmHg) and was significantly reduced at six months to 16.45 mmHg (SD 6.00mmHg, p<0.0001) with 83% of patients below 21mmHg. Best-corrected visual acuity (BCVA) was stable in 83.33% (n=20) of patients and reduced by more than two Snellen lines in 16.67% (n=4). The survival rate of graft at six months was 83.33% (n=20).Fourteen patients had a follow-up at five years with a significantly reduced mean IOP at 14.64mmHg (±3.22mmHg, p<0.0001) with 92.85% (n=13) under 21mmHg and only one patient with a 22mmHg IOP. The mean number of glaucoma medication was significantly reduced from 3.35 (±0.92) pre-treatment to 1.78 (±1.05) post-treatment (p<0.001) at 5 years. BCVA was stable in 57.14% (n=8) of patients and reduced by more than two Snellen lines in 42.86% (n=6) of them. The survival rate of graft at 5 years was 64.29% (n=9), the failure rate was 35.71% (n=5) including one case of failure after rejection (2 years post-TC). There were no reported phtisis or hypotony following TC treatment.
Our results support the hypothesis that TC can efficiently provide glaucoma control in patients after PKP with a good safety profile and compares favorably in terms of PKP survival to GDD as reported in the literature. We suggest that a randomized clinical trial would give more robust data on this topic.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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