Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania

Fieß, Achim; Shah, Peter; Sii, Freda; Furahini, Godfrey; Abbott, Joe; Bowman, Richard; Bauer, Jacqueline; Dithmar, Stefan; Philippin, Heiko

doi:10.1097/ijg.0000000000000682

Cited by 20 publications

(25 citation statements)

References 10 publications

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“… Unlike GDD, it does not lead to a decreased number of glaucoma medications and it is mainly used as an adjunctive therapy (Phelan & Higginbotham 1995; Bock et al 1997; Hamard et al 2000; Neely & Plager 2001; Kirwan et al 2002; Autrata & Rehurek 2003; Carter et al 2007; Cantor et al 2018). There is a general tendency to the rise in IOP probably due to the regeneration of the CP requiring a more frequent need for retreatment (Phelan & Higginbotham 1995; Bock et al 1997; Hamard et al 2000; Neely & Plager 2001; Kirwan et al 2002; Carter et al 2007; Kraus et al 2014; Fieβ et al 2017; 2018; Glaser et al 2019), in particular in young and phakic patients (Kirwan et al 2002). The occurrence of postoperative IOP spikes in the first 3 months leading to IOP surgical management has been described in more than 20% of cases after CW‐TSCPC (Hamard et al 2000).…”

Section: Cw‐tscpc and Ecpmentioning

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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Section: Cw‐tscpc and Ecpmentioning

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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“…(1) Combined trabeculotomy-trabeculectomy 68 (2) Mitomycin-C augmented trabeculectomy 14,73 Glaucoma drainage implantation (1) May consider smaller implant plate designs (2) Plan for possible tube repositioning or extension over the patient's lifetime 85 Cyclophotocoagulation Endoscopic cyclophotocoagulation 87 Goniotomy requires a clear cornea for proper visualization of the angle structures and targets around 120 degrees of the angle when performed in one quadrant through a single incision, as is most common in clinical practice. 47 Its advantages include a short operating time, its conjunctiva-sparing nature, potential for repeatability in another quadrant, and relatively low incidence of complications when performed by a specialist who has experience with this procedure.…”

Section: Trabeculectomymentioning

confidence: 99%

“…In addition, examining pediatric patients can prove difficult in an outpatient setting, increasing the challenge of postoperative assessments of these complications. 13,73 Jayaram et al 74 reported 78% 1-year and 67% 5-year success rate with the use of mitomycin-C (MMC)augmented trabeculectomy in pediatric patients who had failed primary trabeculotomy in a cohort comprising mainly those with PCG. Although GDIs and CPC are reserved for refractory glaucoma cases, where refractory glaucoma refers to patients that have failed prior medical or surgical therapies, GDI is being more frequently employed following failed angle procedures due to its overall better postoperative safety profile.…”

Section: Glaucoma Drainage Implants and Trabeculectomymentioning

confidence: 99%

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Update in Genetics and Surgical Management of Primary Congenital Glaucoma

Mocan¹,

Mehta²,

Aref³

2019

tjo

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Primary congenital glaucoma (PCG) continues to be an important cause of visual impairment in children despite advances in medical and surgical treatment options. The progressive and blinding nature of the disease, together with the long lifespan of the affected population, necessitates a thorough understanding of the pathophysiology of PCG and the development of long-lasting treatment options. The first part of this review discusses the genetic features and makeup of this disorder, including all currently identified genetic loci (GLC3A, GLC3B, GLC3C and GLC3D) and relevant protein targets important for trabecular and Schlemm canal dysgenesis. These target molecules primarily include CYP1B1, LTBP2, and TEK/Tie2 proteins. Their potential roles in PCG pathogenesis are discussed with the purpose of bringing the readers up to date on the molecular genetics aspect of this disorder. Special emphasis is placed on functional implications of reported genetic mutations in the setting of PCG. The second part of the review focuses on various modifications and refinements to the traditional surgical approaches performed to treat PCG, including advances in goniotomy and trabeculotomy ab externo techniques, glaucoma drainage implant surgery and cyclodiode photocoagulation techniques that ultimately provide safer surgical approaches and more effective intraocular pressure control in the 21 st century.

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“…19,20 However, some studies report moderate efficacy even without TI. 21 Many centers in underserved areas may have to use TSCPC as a primary treatment modality 22 and may not have access to a transilluminator.…”

mentioning

confidence: 99%

Diode Laser Transscleral Cyclophotocoagulation With a Novel Low-Cost Torchlight Method of Trans-Corneal Transillumination in Refractory Pediatric Glaucoma

Choudhary,

Snehi,

Singh

et al. 2023

Journal of Glaucoma

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Précis: Transcorneal transillumination aided transscleral cyclophotocoagulation for intraocular pressure control of refractory pediatric glaucoma was found to be effective at 1 year. Purpose: To study one-year outcomes of diode laser transscleral cyclophotocoagulation (TSCPC) with trans-corneal transillumination using a novel low-cost torchlight method in refractory paediatric glaucoma. Methods: This prospective interventional study included children with refractory glaucoma who underwent TSCPC with the Oculight® laser system (IRIS Medical Instruments) with trans-corneal transillumination (TSCPC-TI) using a novel low-cost torchlight method. Children completing a minimum one-year follow-up were analyzed. They were compared to a historical control group of children who underwent TSCPC without transillumination (TSCPC-No TI) at the one-year follow-up period. We analyzed the mean laser energy delivered, post-laser intraocular pressure (IOP) reduction, number of antiglaucoma medications (AGM), the requirement of retreatment and complications of the procedure in both groups. Results: 42 eyes of 35 patients comprised the TSCPC-TI group and were compared with 31 eyes of 21 patients in the TSCPC-No TI group. The TSCPC-TI group required lower energy than the TSCPC-No TI group (24.7+7.8 J versus 47.2+10.9 J, P<0.0001). Mean topical antiglaucoma drug requirement decreased from 2.9+0.08 before treatment to 0.66±0.8 at the end of 1 year in TSCPC-TI and from 2.6+1.0 before treatment to 0.6±0.77 in the TSCPC-No TI groups respectively (P=0.15). There was a significantly reduced dependence of oral acetazolamide in the TSCPC-TI group at 1-year follow-up (5.7% vs 61.9% respectively (P<0.001%). No adverse event of hypotony or choroidal detachment was noted in any group. Conclusions: TSCPC aided by transillumination with a low-cost torchlight for pediatric refractory glaucoma was found to be effective at 1 year in reducing intraocular pressure and the burden of medication.

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Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania

Cited by 20 publications

References 10 publications

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

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

Update in Genetics and Surgical Management of Primary Congenital Glaucoma

Diode Laser Transscleral Cyclophotocoagulation With a Novel Low-Cost Torchlight Method of Trans-Corneal Transillumination in Refractory Pediatric Glaucoma

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