Micropulse laser cyclophotocoagulation in the treatment of secondary glaucoma in patients with post-burn and terminal dystrophic corneal leukoma as a stage of preparation for keratoprosthesis surgery

Abstract

PURPOSE. To evaluate the effectiveness of micropulse laser cyclophotocoagulation (mCPC) in patients with secondary glaucoma associated with post-burn and terminal dystrophic corneal leukomas.METHODS. Twelve patients (12 eyes) with corneal leukomas and secondary glaucoma underwent mCPC. The mean age of the patients was 44±6.5 years, including 8 men and 4 women. All patients exhibited elevated intraocular pressure (IOP), ranging from Tpalp "+" to Tpalp "++," despite being on maximum combination hypotensive therapy. Visual acuity for all patients was 1/∞ light perception with correct projection (proectia lucis certa).RESULTS. On the first postoperative day, IOP was reduced to Tpalp "+" in 4 patients and to Tpalp "N" in 8 patients. Hypotensive therapy was continued based on individual indications throughout the observation period. By day 7, IOP had decreased to Tpalp "N" in all patients and remained stable throughout the follow-up period. Visual acuity in all cases remained unchanged from the preoperative level. Ultrasound biomicroscopy (UBM) revealed that the mean ciliary body thickness (CBT) before surgery was 0.56±0.11 mm. On the first postoperative day, CBT increased by an average of 20.1% due to pronounced edema caused by hydration from the inflammatory response, with a gradual return to baseline by the 1-month follow-up. At 6 months, no statistically significant difference in CBT from the preoperative thickness was observed, with a mean CBT of 0.50±0.12 mm.CONCLUSIONS. Micropulse cyclophotocoagulation can be an effective treatment for secondary glaucoma in patients with post-burn and terminal dystrophic corneal leukomas. This technique reduces the risk of intraoperative and postoperative complications due to its non-invasive nature and low surgical trauma. The procedure can be repeated if IOP increases, and gentle laser parameters can help preserve visual potential.