Prospective evaluation of micropulse transscleral diode cyclophotocoagulation in
            refractory glaucoma: 1 year results

Jammal, Alessandro A.; Costa, Delson João da; Vasconcellos, José Paulo Cabral de; Costa, Vital Paulino

doi:10.5935/0004-2749.20190076

Cited by 28 publications

(35 citation statements)

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“…Although the pain was less after retreatment, we can assume that there were local inflammatory factors generating persistent pain, along with an associated surface pathology in both cases. Our retreatment rate (1%) was significantly lower than in the literature, with retreatment rates ranging from 6% to 33% in the most recent studies [8,9,20,[25][26][27]. However, our population was small and we did not indicate a second treatment if the patient was no longer in pain.…”

Section: Discussioncontrasting

confidence: 71%

Subliminal Diode Treatment of the Ciliary Bodies by Transscleral Cyclophotocoagulation with a 31.3% Duty Cycle in the Treatment of Refractory Glaucoma: Safety and Efficacy

Zerin¹,

Karine²,

Etselle³

et al. 2021

Int J Ophthalmol Clin Res

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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.

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Section: Discussioncontrasting

confidence: 71%

Subliminal Diode Treatment of the Ciliary Bodies by Transscleral Cyclophotocoagulation with a 31.3% Duty Cycle in the Treatment of Refractory Glaucoma: Safety and Efficacy

Zerin¹,

Karine²,

Etselle³

et al. 2021

Int J Ophthalmol Clin Res

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“…To calculate the power of a study that is already completed, we need the surgical success rate mentioned in previous literature, success rate in the present study and sample size of present study. The success rate mentioned in the following recent studies is 60-71% [12][13][14]. Post-hoc power calculation based on surgical success mentioned in the recent literature showed that power of the present study is 92.7%.…”

Section: Resultsmentioning

confidence: 47%

Micropulse trans-scleral diode laser cyclophotocoagulation in refractory glaucoma: an initial experience in Indian eyes

Ariga¹,

Nivean²,

Nivean³

et al. 2021

Int Ophthalmol

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Purpose To evaluate the efficacy and safety of micro-pulse trans-scleral diode laser cyclophotocoagulation (MP-TSCPC) in Indian eyes with refractory glaucoma. Methods A prospective interventional short-term study was carried out with relatively small sample size of 55 eyes with refractory glaucoma. All eyes had visual acuity (VA) and intraocular pressure (IOP) measurements at baseline, 1 week (1w), 1 month (1 m) and 3 months (3 m). A single surgeon treated all eyes with recommended MP-TSCPC treatment settings. Surgical success was defined as achieving an IOP between 8–21 mmHg or achieving > 20% IOP reduction. Results The age of participants was 56.98 ± 15.74 years. Our study had more number of males. VA (in logMAR) at baseline was 1.38 ± 0.99. VA was 1.43 ± 0.93 at 1w, 1.47 ± 0.94 at 1 m and 1.47 ± 0.96 at 3 m (p > 0.05 for all). IOP (in mmHg) at baseline was 30.38 ± 10.70. IOP was 15.72 ± 6.85 at 1w, 16.98 ± 8.72 at 1 m and 17.60 ± 8.40 at 3 m (p < 0.001 for all). At 3 m, 49 (89.1%) eyes had surgical success. Surgical success was lesser in primary open angle glaucoma (p = 0.03). IOP at baseline showed significant correlation with percentage reduction in IOP at each review (p < 0.05). Use of glaucoma medication reduced from 2.94 ± 0.98 to 2.01 ± 1.16 at 3 m (p < 0.001). At 3 m, hypotony was noted in 4 (7.3%) eyes and reduction in visual acuity was seen in 15 (27.3%) eyes. Conclusion Initial experience in Indian eyes has shown that MP-TSCPC is safe and effective for refractory glaucoma. Patients can expect significant IOP lowering along with reduction in number of topical medications required for control of IOP.

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“…However, due to the small sample size, the univariate and multivariate logistic regression analyses did not allow identifying it as a predictor of failure. Other series including large proportions of NVG eyes have not shown lower success rates with this type of glaucoma (Al Habash & AlAhmadi 2019; Jammal et al 2019; Tekeli & Köse 2020). Yelenskiy et al (2018) have found that eyes with POAG showed a higher success rate than eyes with NVG or other diagnoses (OR: 3.4; 95% CI: 1.4–8.9). History of filtering surgery: In the study by Garcia et al (2019), the eyes with a history of traditional glaucoma surgery (trabeculectomy, tube shunt, excessive pressure‐regulating shunt system/miniature glaucoma shunt [Alcon, Fort Worth, TX] or a combination of both) showed a higher success rate (67.6%) than eyes with no history of glaucoma surgery (41.4%; p = 0.014).…”

Section: Mp‐tltmentioning

confidence: 89%

“…This method could have lead to cyclophotocoagulation, as the total laser application duration was greater than 3 s per site, which is longer than the commonly used transscleral cyclophotocoagulation, despite not using a continuous motion and, therefore, the thermal effect was lower than with the traditional technique. Retreatments: the literature on retreatment is limited. The studies with the highest retreatment rates (≥20%) were those in which the delivered energies were modest (<100 J) (Tan et al 2010; Aquino et al 2015; Elheifney et al 2019; Nguyen et al 2019; de Crom et al 2020; Radhakrishnan et al 2020; Tekeli & Köse 2020) and/or the mean preoperative IOP was too high (>30 mmHg) to reach the success endpoint after a single session (Tan et al 2010; Aquino et al 2015; Elheifney et al 2019; Jammal et al 2019; Preda et al 2020; Tekeli & Köse 2020). Tekeli & Köse (2020) have found a significantly higher retreatment rate in eyes with other types of secondary glaucoma than in eyes with POAG and PXG.…”

Section: Mp‐tltmentioning

confidence: 99%

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

Souissi¹,

Mer²,

Metge³

et al. 2020

Acta Ophthalmologica

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Purpose Continuous‐wave cyclophotocoagulation (CW‐CPC) is often preferred to medical and surgical treatments for managing refractory glaucoma. This review summarizes diode CW‐CPC indications, history, histopathology, methods, efficacy and safety. It also provides an overview of the latest data available on micropulse transscleral laser treatment (MP‐TLT) that uses repetitive micropulses of diode laser energy in an off‐and‐on cyclical fashion. Methods A literature review was conducted on transscleral CW‐CPC (CW‐TSCPC), endoscopic CPC (ECP) and MP‐TLT. Relevant series of adult and paediatric patients were included for assessing the procedures. Results Regarding CW‐TCPC, highly variable success rates are reported in the literature, depending on the definition of success, type of underlying glaucoma, energy settings, follow‐up duration and retreatment rates. CW‐CPC often needs to be repeated, especially in paediatric patients. CW‐CPC exposes to risks of inflammation and chronic ocular hypotony or phthisis with irreversible visual loss. CW‐TSCPC has mainly been used in very severe forms of glaucoma, in painful eyes with limited visual potential or after filtering surgery failure. Published data on ECP are more limited but overall good success rates have been reported. Through the direct visualization of the targeted ciliary body in anatomically abnormal eyes, ECP is the preferred surgical procedure in paediatric refractory glaucoma. Complication rates are relatively low after ECP; however, large studies with long‐term follow‐up are needed. ECP may be used in difficult, refractory cases, but it is often used earlier when combined with cataract surgery. Despite limited data on the exact mechanism of action of MP‐TLT and a lack of standardization of laser settings, the first data from heterogeneous case series shows that it has a similar efficacy and a better safety profile compared to CW‐TSCPC in the medium term. Conclusion Although they may lead to sight‐threatening complications, both CW‐TSCPC and ECP seem effective. ECP appears to be superior to CW‐TSCPC in paediatric refractory glaucoma. Unlike ECP combined with cataract surgery, evidence supporting a wider use of CW‐TSCPC and MP‐TLT in earlier stages of neuropathy is lacking. While it now appears that the safety profile of MP‐TLT is superior to that of CW‐CPC, robust prospective comparative studies including homogeneous and well‐defined cohorts of patients are still needed to confirm an at least comparable efficacy in the long term.

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Prospective evaluation of micropulse transscleral diode cyclophotocoagulation in refractory glaucoma: 1 year results

Cited by 28 publications

References 0 publications

Subliminal Diode Treatment of the Ciliary Bodies by Transscleral Cyclophotocoagulation with a 31.3% Duty Cycle in the Treatment of Refractory Glaucoma: Safety and Efficacy

Subliminal Diode Treatment of the Ciliary Bodies by Transscleral Cyclophotocoagulation with a 31.3% Duty Cycle in the Treatment of Refractory Glaucoma: Safety and Efficacy

Micropulse trans-scleral diode laser cyclophotocoagulation in refractory glaucoma: an initial experience in Indian eyes

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

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