Diode laser transscleral cyclophotocoagulation followed by phacotrabeculectomy on medically unresponsive acute primary angle closure eyes: the long-term result

Abstract

BackgroundTo explore the intraocular pressure-lowering effect and complications of diode laser transscleral cyclophotocoagulation (DLTSC) followed by phacotrabeculectomy on medically unresponsive acute primary angle closure eyes.MethodsNine eyes of nine medically unresponsive acute primary angle closure patients were enrolled. All the patients underwent cyclophotocoagulation followed by phacotrabeculectomy to control the prolonged acute attack. Data were recorded prospectively and then analyzed retrospectively. The reduction in intraocular pressure, improvement of vision and the complications were evaluated.ResultsAfter DLTSC, the IOP of all the patients were reduced, but all were above 21 mmHg under topical anti-glaucoma medications. After phacotrabeculectomy, the IOP of all the patients was decreased. At the final visit, the vision of all the patients was improved and the IOP of all the patients was below 21 mmHg without anti-glaucoma medications. There were no complications during the DLTSC and phacotrabeculectomy. Uveitis was the common complications after the both procedures, which were resolved by medication treatment.ConclusionDiode laser transscleral cyclophotocoagulation followed by phacotrabeculectomy is an alternative procedure to control the intraocular pressure of medically unresponsive acute primary angle closure eyes with few complications.

Transscleral cyclophotocoagulation in refractory acute and chronic angle closure glaucoma

“…Sequential lensectomy with or without trabeculectomy may then be undertaken if indicated. A minority of patients with AACG do not respond to topical and systemic antihypertensive agents 3 6. Corneal oedema may prevent laser intervention (argon iridoplasty or YAG iridotomy) even if the cornea can be temporarily cleared, and a shallow anterior chamber risks injury to the lens capsule if paracentesis is attempted.…”

“…TSCP has recently been described as a safe and effective management strategy in AACG refractory to medical therapies to achieve IOP control 3 6. One series identified five patients with refractory AACG who underwent non-urgent TSCP between 2 and 23 days of presentation with all patients maintaining 6/12 vision or better following delayed, sequential lensectomy.…”

“…Chronic or subacute onset angle closure may not produce significant corneal oedema and it is likely that laser peripheral iridotomy will be undertaken. However, this intervention alone may not achieve IOP control, particularly in East Asian eyes 6 12. Intraocular procedures such as lensectomy and trabeculectomy may be similarly undesirable in the setting of uncontrolled IOP 7…”

Acute primary angle closure–treatment strategies, evidences and economical considerations

“…In cases were APAC could not be controlled by the methods mentioned above, alternative strategies could also be used. Diode laser transscleral cyclophotocoagulation (DLTSC) was reported to be a possible alternative in treating APAC [18,19]. This allows more rapid lowering of IOP and reduces corneal oedema for further intervention.…”

Lasers in glaucoma

“…Iridocyclitis (42%) is common after the procedure, due to a breakdown of the blood–aqueous barrier. [ 109 125 126 127 ] Transient rise of IOP can occur, along with corneal edema and corneal epithelial defects (9% of cases). [ 126 ] Cataract can develop in around 12% of cases.…”