Micropulse transscleral cyclophotocoagulation using a standard protocol in patients with refractory glaucoma naive of cyclodestruction. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Souissi, Soufiane; Baudouin, Christophe; Labbé, Antoine; Hamard, Pascale
• Is Part Of: European journal of ophthalmology. Volume 31:Issue 1(2021)
• Page Start: 112
• Page End: 119
• Publication Date: 2021-01
• Subjects: Micropulse cyclophotocoagulation -- refractory glaucoma -- laser outcomes -- intraocular pressure; Ophthalmology -- Periodicals; Eye -- Diseases -- Periodicals; 617.7005
• DOI: 10.1177/1120672119877586
• Languages: English
• ISSNs: 1120-6721

Abstract

Purpose: To assess the efficacy and safety of a standardized micropulse transscleral diode laser cyclophotocoagulation procedure in refractory glaucoma. Methods: Retrospective, interventional study in a series of 37 consecutive patients with refractory glaucoma, cyclodestructive procedure-naive, who underwent micropulse transscleral diode laser cyclophotocoagulation from December 2016 to October 2017. A successful laser treatment was defined as (1) intraocular pressure between 6 and 18 mm Hg; (2) 20% of baseline intraocular pressure reduction; (3) no additional glaucoma medications; (4) no decrease in vision due to complications or change in intraocular pressure; and (5) no need for additional glaucoma surgery except micropulse transscleral diode laser cyclophotocoagulation retreatment. Results: Mean age was 60.2 years. Mean follow-up was 9.7 ± 3.9 months. The mean preoperative intraocular pressure (28.7 mm Hg) significantly decreased to 21.0 mm Hg at 1 month, 18.5 mm Hg at 3 months, 18.4 mm Hg at 6 months, and 18.5 mm Hg at 12 months ( p < 0.01 at all time points). The mean number of preoperative glaucoma medications (4.7) decreased to 4.0 at 1 month ( p = 0.14), 4.5 at 3 months ( p < 0.05), 3.9 at 6 months ( p < 0.05), and 3.6 at 12 months ( p < 0.05). At 1 year, the success rate was 35% with a mean intraocular pressure lowering of 36%. One patient had hypotony and a loss of best-corrected visual acuity. Mild transient postoperative inflammation was observed in 8% of the cases. Conclusion: Using a standardized procedure, micropulse transscleral diode laser cyclophotocoagulation allows a mild intraocular pressure decrease with a low rate of complications and thus achieves a relatively good profit risk benefit, mostly for moderately hypertensive refractory glaucoma.