Transcleral Cyclophotocoagulation Using Slow Burn Technique in Glaucoma Secondary to Vitreoretinal Surgeries: One-Year Results

Abstract

Purpose : The management of secondary glaucoma following vitreoretinal surgeries is challenging as postoperative conjunctival scarring and subconjunctival migration of silicone oil may limit the success of conventional filtration and tube surgeries. We report the treatment outcomes of slow burn transscleral cyclophotocoagulation (TSCPC) as a primary glaucoma surgical technique in the management of secondary glaucoma attributed to prior vitreoretinal surgeries.

Methods : A retrospective study of 18 eyes of 18 patients with medically uncontrolled glaucoma secondary to pars plana vitrectomy (PPV) with silicone oil injection (SOI) and no history of previous incisional glaucoma or cyclodestructive procedures, who underwent TSCPC using slow burn settings (1250-milliwatt power and 4-second duration). The primary outcome: surgical success at 1 year defined as intraocular pressure (IOP) 6 - 21 mmHg and reduced ≥ 20% from baseline, no incisional glaucoma reoperation, and no loss of light-perception vision. Secondary outcomes included glaucoma medication use, visual acuity (VA) changes, and surgical complications.

Results : The mean age of the patients at time of surgery was 52.0 ± 17.4 years, and the mean follow-up duration was 18.1 ± 4.7 months. At 1 year, IOP decreased from 29.7 ± 9.6 mmHg to 14.6 ± 6.5 mmHg with mean IOP reduction of 45.8 % (p < 0.001). The baseline number of glaucoma medications was 4.2 ± 0.9 at baseline and 1.9 ±1.3 at 1 year after TSCPC (p < 0.001). A non-significant change in logMAR VA from 1.36 ± 6.8 at baseline to 1.29 ± 0.79 at 1 year was reported (p=0.722). The success rate at 1 year was 72.2 %. Two eyes (11.1%) had TSCPC retreatment. One eye (5.6%) required incisional glaucoma reoperation. Complications included: iritis in 2 eyes (11.1%), macular edema in 1 eye (5.6%), hypotony transient in 1 eye (5.6%) and hyphema in 1 eye (5.6%).

Conclusions : Slow burn TSCPC as a primary glaucoma surgical procedure in patients with secondary glaucoma following PPV and SOI has high efficacy and minimal complications. Prospective studies with a larger number of participants are needed to confirm our encouraging results.

This is a 2021 ARVO Annual Meeting abstract.