Diode laser trans-scleral cyclophotocoagulation in the management of glaucoma in patients with long-term intravitreal silicone oil

Abstract

Aims To analyse the results of contact transscleral cyclodiode photocoagulation (TSCPC) in reducing intraocular pressures (IOP) refractory to medical treatment in a group of patients with intravitreal silicone oil. Methods The medical records of 18 patients who received TSCPC were evaluated retrospectively. Success was evaluated primarily in terms of IOP control. Success was defined as a final IOP of less than 22 mmHg Results In all, 18 eyes of 18 patients were followed up for an average of 21.8 months (range 6-36) (SD ¼ 8.6). The mean pretreatment IOP was 39.6 mmHg (range 25-56 mmHg) (SD ¼ 9.3). This reduced to 20.0 mmHg (range 0-48, SD ¼ 13.5) after TSCPC, producing a mean reduction of 49% from mean pretreatment IOP levels. The overall success rate was 44% (eight eyes). Chronic hypotony occurred in two patients. IOP remained above that required to meet the IOP reduction criteria in eight patients. Conclusion Our results raise doubts about the efficacy of TSCPC in the management of glaucoma in eyes retaining silicone oil. This may relate to the long duration of silicone oil in our patients. Further studies are required to identify risk factors for treatment failure.

Silicone oil induced glaucoma: A review

“…Sivagnanavel [85] had a lower success rate for IOP reduction (56% treatment failure), despite the use of higher mean laser energies and a higher re-treatment rate. Multiple treatments may be required to attain intraocular pressure control, and since there is a risk of visual loss it is reserved for eyes with poor visual potential.…”

Silikon Emülsifikasyonuna Bağlı Kontrol Edilemeyen Göz İçi Basıncı Yüksekliğinde Transskleral Diod Lazer Siklofotokoagülasyon

“…31 Schuman et al reported a 10% incidence of hypotony and phthisis after cyclophotocoagulation. 32 Also, Sivagnanavel et al 26 reported chronic hypotony in two patients (11%) after TDCP in patients with refractory glaucoma secondary to intravitreal SiO. In our study, hypotony occurred only in one patient at 1 month and it was resolved one week later.…”

“…Bloom et al achieved a 51% reduction in mean pre-treatment IOP in 36 patients with SiO-induced glaucoma and their overall success rate was 69% for an IOP under 22 mmHg.11 Sivagnanavel et al reported a 44% IOP reduction with TDCP at final follow-up visit. 26 However, Han et al reported 100% success in IOP reductions at the final follow-up. 12 But several factors, such as length of follow-up period and number of patients (11 patients) are the limitations of their study.…”

“…Sivagnanvel et al reported that the mean number of IOP-lowering medications reduced from 2.6 to 1. 26 The complications after TDCP include conjunctival burns, pain, vision loss, hyphema, uveitis, cataract progression, hypotony, choroidal detachment, and phthisis. 12,26,[28][29][30] In our study, the main complication was transient pain in 9 eyes.…”

Glaucoma After Retinal Surgery

“…However, a glaucoma drainage implant is useful for the treatment of elevated IOP in eyes that do not respond to medical therapy [ 24 , 26 ]. Transscleral diode cycloablation is recommended for patients with a poor visual prognosis and can achieve a reduction in IOP of approximately 49 % from baseline IOP with success rates of 44 % [ 27 ].…”