July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Efficacy of Transcleral Diode Cyclophotocoagulation in a sub-Saharan Rural Population with Severe Glaucomatous Ocular Hypertension
Author Affiliations & Notes
  • vincent Mkwezgalamba saka
    Ophthalmology, Eyes of Africa Clinic, Child Legacy Hospital, Msundwe, Central Province, Malawi
    Sponsel Foundation/Child Legacy International, Msundwe, Malawi
  • Richard Chitedze
    Ophthalmology, Eyes of Africa Clinic, Child Legacy Hospital, Msundwe, Central Province, Malawi
    Sponsel Foundation/Child Legacy International, Msundwe, Malawi
  • Scott Sullivan
    Ophthalmology, New York Medical College, Valhalla, New York, United States
  • Abha Amin
    Ophthalmology, New York Medical College, Valhalla, New York, United States
  • Mario Montelongo
    School of Medicine, Universidad de Guadalajara, Guadalajara, Guadalajara, Mexico
  • William Eric Sponsel
    Visual Sciences/Biomedical Engineering, UIW/UTSA, San Antonio, Texas, United States
    Sponsel Foundation/Child Legacy International, Msundwe, Malawi
  • Footnotes
    Commercial Relationships   vincent saka, None; Richard Chitedze, None; Scott Sullivan, None; Abha Amin, None; Mario Montelongo, None; William Sponsel, None
  • Footnotes
    Support  Sponsel Foundation, Child Legacy International, Iridex (equipment support)
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 707. doi:
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      vincent Mkwezgalamba saka, Richard Chitedze, Scott Sullivan, Abha Amin, Mario Montelongo, William Eric Sponsel; Efficacy of Transcleral Diode Cyclophotocoagulation in a sub-Saharan Rural Population with Severe Glaucomatous Ocular Hypertension. Invest. Ophthalmol. Vis. Sci. 2019;60(9):707.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Gross elevation of intraocular pressure in patients with end stage glaucoma can be accompanied by chronic frontal headache, stabbing eye pain, and autonomic side effects including hyperhidrosis, indigestion, nausea, and cardiac arrhythmia. Topical antiglaucoma medications in rural sub-Saharan Africa are typically reserved for treatment of patients with survival of reading vision. This study assesses the efficacy of trans-scleral diode cyclodestruction in eyes of Malawian adult patients with uncontrolled ocular hypertension and BCVA of HM or worse.

Methods : Consenting adult patients with end-stage glaucoma and uncontrolled ocular hypertension were treated ab externo with Iridex SLx 810 diodle laser via G-probe after placement of retrobulbar lidocaine under IRB-approved protocol. Applanation IOP at each visit was measured independently by 2 clinicians, and their readings averaged. IOP Change from baseline at each time interval was assessed by paired t-test.

Results : 40 eyes of 33 patients (28M,5F; mean age 60) were treated. A mean of 19 spots were placed (+/-sem0.6) at a mean setting of 2059(+/-162)mW. Mean pre-treatment IOP was 38.1(+/-1.9)mmHg. Post-treatment IOP values at 1, 2 and 4 months were 24.3(+/-1.7), 22.8(+/-1.6) and 19.1(+/-1.1)mmHg, respectively (P<0.00001 for all three intervals). Visual acuity was not significantly altered (2 eyes improved, all others stable), but symptomatic relief was reported by a majority of those undergoing diode laser treatment. No significant complications were encountered.

Conclusions : Mean intraocular pressure was decreased by 36%, 40%, and 50% at one, two and four months after trans-scleral diode cyclophotocagulation, achieving normal mean IOP level by 4 months without additional therapy. The diode treatments fit well into the clinical routine, and these very encouraging results with standard trans-scleral diode in end-stage patients has motivated us to move forward with a similar prospective program of micropulse diode cyclophotooagulation for patients with moderate to severe glaucoma.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Intraocular pressure response to diode cyclophotocoagulation among rural Malawian adults with end stage glaucoma, showing decrease in IOP from a mean value approaching central retinal diastolic pressure to normal IOP level by 4 months.

Intraocular pressure response to diode cyclophotocoagulation among rural Malawian adults with end stage glaucoma, showing decrease in IOP from a mean value approaching central retinal diastolic pressure to normal IOP level by 4 months.

 

Rand Allingham of Duke University examining a patient at the Eyes of Africa Clinic, Msundwe, Malawi.

Rand Allingham of Duke University examining a patient at the Eyes of Africa Clinic, Msundwe, Malawi.

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