Diode laser cyclophotocoagulation paves way to a safer trabeculectomy in eyes with medically uncontrollable intraocular pressure

Abstract

High intraocular pressure (IOP) not responding to systemic and topical anti-glaucoma medications renders the eye at risk for both intra- and post-operative complications of glaucoma filtration surgery. Laser cyclophotocoagulation is able to lower IOP in such refractory glaucoma eyes and may make the surgical event safer. This study assessed diode laser cyclophotocoagulation (DLCP) when used as a temporary measure for lowering IOP prior to performing trabeculectomy. This study is a retrospective analysis of cases planned for trabeculectomy surgery, uncontrolled on maximally tolerable systemic anti-glaucoma medications. They were analysed for response to DLCP in terms of IOP control, vision-related complications, increased inflammation, post-trabeculectomy hypotony and chances of phthisis and ciliary shutdown. Twelve eyes of ten patients aged 35-65 years were identified and all followed up for at least 2 years. One week following DLCP, the IOP (mean ± SD) declined by 51 % from 46.8 ± 5.4 to 22.8 ± 3.3 mmHg. The IOP was further reduced to 15.4 ± 2.7 mmHg at 4 weeks after trabeculectomy; it remained in the mid-teens for a minimum of 2 years in all cases. The mean (±SD) visual acuity improved from 1.4 ± 0.4 to 0.8 ± 0.4 LogMAR equivalents following trabeculectomy. In four eyes, phacoemulsification was performed 5-7 months after trabeculectomy with improvement in best-corrected visual acuity. One patient developed transient hypotony, post-trabeculectomy, which resolved by 6 days. There were no other complications like increased inflammation, prolonged hypotony or suprachoroidal haemorrhage. DLCP is, thus, effective and safe for temporarily controlling IOP; thereby trabeculectomy can be performed in a quieter ocular milieu.

An update on continuous‐wave cyclophotocoagulation (CW‐CPC) and micropulse transscleral laser treatment (MP‐TLT) for adult and paediatric refractory glaucoma

“…Although CPC has been studied in the early stages of glaucoma (Egbert et al 2001; Kramp et al 2002; Singh et al 2017b; Abdull et al 2018), its complications remain common enough to limit its use to the treatment of glaucoma refractory to conventional surgical treatments (Michelessi et al 2018; Hasan et al 2019; Paul et al 2019) (Table 3). Moreover, the inflammatory (mostly CD4 T‐cell lymphocytic infiltrates) and fibrotic histological conjunctival lesions induced by the procedure are likely to impair future filtration blebs (Tan et al 2019).…”

Outcome of Micropulse Laser in Treatment of Open Angle Glaucoma in a Peripheral Hospital in Rivers State, Nigeria: Our Initial Experience

“…These findings were also corroborated by Kuchar et al [13] in advanced glaucoma patients, who reported a mean IOP drop of 40.1% and a mean follo time of 60 days with minimal complications. Singh et al [14] studied its use as a temporary measure to lower IOP before trabeculectomy in refractory glaucoma and reported 51% reduction in IOP by one week. Our study population was however made up of only POAG patients.…”

Does prior endoscopic cyclophotocoagulation (ECP) affect subsequent trabeculectomy outcomes?

“…Consequently, cyclo-ablative laser procedures have traditionally been reserved for eyes with poor visual potential, or as a last resort after multiple glaucoma filtration surgeries have failed [ 1 ]. Although there is some, albeit limited, evidence to suggest the safety and efficacy of transscleral diode laser cyclophotocoagulation for temporary intraocular pressure (IOP) control for medically refractory glaucoma prior to trabeculectomy surgery [ 2 ], general consensus has been to avoid cyclo-destructive procedures prior to a trabeculectomy.…”