Purpose: Micropulse Transscleral diode laser cyclophotocoagulation (MP-TSCPC) is an established method of treatment for refractory glaucoma. This study evaluates the efficacy in terms of reduction in intraocular pressure and/or treatment amount, and safety and side effects of the ciliary bodies using a subthreshold laser with a duty cycle of 31.3% with Supra 810 nm Subliminal Quantel Medical, at one year in patients with refractory glaucoma. Methods: A retrospective, observational, single-center study conducted between January 2019 and November 2019 at Nancy University Hospital, includes 22 eyes. The inclusion criteria was patients with refractory glaucoma, defined as glaucoma with no longer response to medical or surgical treatment and/or painful eye. The exclusion criteria was eye which received any other procedure in order to destroy or weaken the ciliary body. All patients were reviewed at one week, one month and one year in post-operative period. Aetiology of glaucoma, history of surgery, change in intraocular pressure (IOP), glaucoma medication, visual acuity, pain symptoms, assessment of ocular surface pathology, and complication rate were documented. Results:The study included 22 patients: 9 patients were female and 13 patients were male, and the mean age was 71.4 ± 15 years. The pre-operative mean IOP was 37.5 ± 8 mmHg and 26.5 ± 12 mmHg after laser procedure. The mean IOP reduction was 44.8% at one week, 30.4% at one month and 29.3% at one year after treatment, which was statistically significant (P value < 0.05, paired Student's t-test). 93.7% of patients had improvement in pain symptoms after MP-TSCPC. The assessment of the surface pathology showed improvement in Oxford score that fell from 1.3 to 1. The mean number of ocular antihypertensive medication used was 2.2 before treatment and decreased to 1.7 one year after treatment, which represent a reduction of 25.1% of treatment score. All patients had unchanged visual acuity post-operatively except two. No significant complications or anatomic modifications were found after subliminal cyclophotocoagulation. Conclusion:Subliminal cyclophotocoagulation with 31.3 duty cycle is effective and safe procedure for reducing IOP and/or pain in cases of refractory glaucoma.
Purpose: The objective of this study was to observe the 1-year pressure gain in a consecutive series of glaucoma patients treated by selective laser trabeculoplasty, along with the clinical and technical characteristics that influence the evolution of intraocular pressure after treatment. Materials and methods:We carried out a retrospective study of all patients treated in the ophthalmology department of Nancy University Hospital between January 2015 and March 2016. Treatment was performed with a Q-Switched, frequency doubled Nd: YAG laser (Solutis -Quantel Medical, France), over 180° or 360° of the trabecular meshwork. The mean decreases in Intraocular pressure and the success rate (defined as a decrease in intraocular pressure of ≥ 20% at 1 year without increasing the medical treatment) were calculated. The impact of the different clinical and technical characteristics of each case on the decrease in pressure was also studied by bivariate analysis. Results:One hundred and nineteen eyes, in 78 patients, were included. The decrease in IOP at 1 year was in mean of 4.2 mmHg (Standard Deviation = 5.37), and of 19.6% from baseline. The success rate was 46.7%. Only two minor and reversible complications occurred during the follow-up period.Discussion: Selective trabeculoplasty is currently a therapeutic option called-upon at different stages in the progression of glaucoma. The duration of efficacy of this laser therapy, and the retreatment frequency are yet to be defined.
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