Treatment Outcomes of Slow Coagulation Transscleral Cyclophotocoagulation In Pseudophakic Patients with Medically Uncontrolled Glaucoma

Khodeiry, Mohamed M.; Sheheitli, Huda; Sayed, Mohammed S.; Persad, Patrice J.; Feuer, William J.; Lee, Richard K.

doi:10.1016/j.ajo.2021.04.003

Cited by 20 publications

(66 citation statements)

References 27 publications

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“…In the present study, MP-TLT proved superior success rates to those achieved by Khodeiry et al in their recently published study on slow-coagulation CW-TSCP (i.e., 60.6% at 1 year) [ 52 ]. The slow-coagulation protocol uses a power of 1,250 mW and a duration of 4,000 ms rather than 2,500 mW and 2,000 ms.…”

Section: Discussioncontrasting

confidence: 39%

MicroPulse Transscleral Laser Therapy Demonstrates Similar Efficacy with a Superior and More Favorable Safety Profile Compared to Continuous-Wave Transscleral Cyclophotocoagulation

Enrico

Töteberg‐Harms

2022

Journal of Ophthalmology

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Purpose. The aim of this study was to compare effectiveness and safety of MicroPulse transscleral laser therapy (MP-TLT) using the original MicroPulse P3® device and continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) using the G-Probe® device in glaucoma. Methods. Spherical equivalent, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of topical or oral ophthalmic pressure-reducing medications were registered at every time point, up to the last follow-up at 12 months. A complete slit-lamp examination was conducted to record the following complications: corneal edema, persistent ocular hypotony (IOP ≤5 mmHg) on two consecutive follow-up visits, choroidal detachment, phthisis bulbi, sympathetic ophthalmia, cystoid macular edema, or other abnormal ocular findings. Success was defined as IOP between 6 and 21 mmHg and >20% reduction in IOP with or without antiglaucoma medications. Results. 47 eyes underwent MP-TLT and 150 CW-TSCPC. At 12 months, success was achieved in 88.6% in the CW-TSCPC group and 87.5% in the MP-TLT group ( p = 0.883). In the CW-TSCPC group, eyes achieved a 42.4% IOP reduction (from 28.3 ± 12.3 mmHg to 15.3 ± 6.0 mmHg) and a 31.1% reduction (from 22.0 ± 7.2 mmHg to 15.7 ± 4.8 mmHg) in the MP-TLT group. Visual acuity remained primarily unaltered in both groups. Conclusion. MP-TLT was as effective in lowering IOP as CW-TSCPC and achieved comparable success. Additionally, MP-TLT demonstrated consistent and effective outcomes at every time point. The improved safety profile of MP-TLT allows the therapeutic spectrum to be broadened, granting ophthalmologists’ treatment of glaucoma in earlier stages of glaucoma than those typically treated with CW-TSCPC, i.e., early to moderate and to patients with good central-vision.

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Section: Discussioncontrasting

confidence: 39%

MicroPulse Transscleral Laser Therapy Demonstrates Similar Efficacy with a Superior and More Favorable Safety Profile Compared to Continuous-Wave Transscleral Cyclophotocoagulation

Enrico

Töteberg‐Harms

2022

Journal of Ophthalmology

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“…In a series of 74 pseudophakic patients with glaucoma, with a mean follow-up of 18.7 months, after slow-coagulation CW-TSCPC, IOP decreased from 27.5 ± 9.8 mmHg to 16.1 ± 6.3 mmHg and number of medications from 4.1 ± 0.9 to 3.1 ± 1.3. 7 Similarly, in a study that included patients with complex and difficult-to-treat silicone oil-induced glaucoma, at one year the mean IOP reduction percentage from baseline was 45.8% and a success rate of 72.2% with a significant reduction in the required glaucoma medications. 25 Although filtration surgeries and GDDs are efficacious treatment options in secondary keratoplasty-induced glaucoma, their effect on the graft condition and the presence of viable conjunctiva is of concern for successful surgery and minimal post-operative complications.…”

Section: Discussionmentioning

confidence: 96%

“…On the other hand, the slow-coagulation technique includes application of a lower amount of fixed laser energy over the ciliary body for a longer duration and is less inflammatory compared to the conventional technique of CW-TSCPC. 4,5 Although previous reports suggest favorable treatment results for slow-coagulation TSCPC, 6,7 limited data are available about its role in the treatment of secondary glaucoma following keratoplasty. Here, we evaluate the treatment outcomes of slow-coagulation CW-TSCPC in glaucoma following PKP or DSAEK surgeries.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation

Liu

Sayed

Khodeiry

2023

European Journal of Ophthalmology

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Purpose To report the outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in post-keratoplasty glaucoma refractory to medical therapy. Methods Medical records of 47 patients (mean age of 70.7 ± 15.7 years and follow-up of 13.9 ± 7.1 months) were retrospectively enrolled. All patients had the diagnosis of secondary glaucoma after penetrating keratoplasty (PKP; n = 28) or Descemet's stripping automated endothelial keratoplasty (DSAEK; n = 19) with no previous history of incisional glaucoma or TSCPC surgeries. Study participants underwent slow-coagulation CW-TSCPC (1250-milliwatt power and 4-second duration). Results A statically significant reduction of IOP from 31.8 ± 8.0 mmHg preoperatively to 16.9 ± 9.0 mmHg postoperatively was noted ( p < 0.001). Similarly, the number of glaucoma medications decreased from 4.0 ± 1.0 to 2.7 ± 1.4 ( p < 0.001). The overall success rates at 12 and 24 months were 68.1% and 66.0%, respectively, with no difference in success rates between post-PKP and post-DSAEK subgroups ( p = 0.836). No significant changes in VA or central corneal thickness (CCT) were observed ( p = 0.345 and 0.311, respectively). One (3.3%) patient had a graft rejection. The majority of the complications noted during this study were mild and transient. Conclusions Our study suggests that slow-coagulation TSCPC may be a safe and efficient surgical glaucoma treatment modality in patients with medically uncontrolled post-keratoplasty glaucoma.

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“…As the site of aqueous humor production, the CP is also the site of surgical interventions, such as trans-scleral cyclo-photocoagulation (TSCPC), endoscopic cyclophotocoagulation (ECP), and ultrasound cycloplasty (UCP), which are aimed at destroying the CB to reduce IOP in glaucoma patients [28][29][30]. Therefore, images of the ciliary process using UBM could provide a more refined observation method to evaluate the morphological changes of the ciliary process in TSCPC-, ECP-, and UCP-treated glaucoma and the relationship between the morphological changes and IOP reduction.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the Ciliary Body in Healthy Chinese Subjects Evaluated by Radial and Transverse Imaging of Ultrasound Biometric Microscopy

Ren

Gao

Chen

et al. 2022

JCM

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Background: The imaging and analysis of the ciliary body (CB) are valuable in many potential clinical applications. This study aims to demonstrate the anatomy characteristics of CB using radial and transverse imaging of ultrasound biometric microscopy (UBM) in healthy Chinese subjects, and to explore the determining factors. Methods: Fifty-four eyes of 30 healthy Chinese subjects were evaluated. Clinical data, including age, body mass index (BMI), intraocular pressure (IOP), axial length (AL), and lens thickness (LT), were collected. Radial and transverse UBM measurements of the ciliary body were performed. Anterior chamber depth (ACD), ciliary sulcus diameter (CSD), ciliary process length (CPL), ciliary process density (CPD), ciliary process area (CPA), ciliary muscle area (CMA), ciliary body area (CBA), ciliary body thickness (CBT0, CBT1, and CBTmax), anterior placement of ciliary body (APCB), and trabecular-ciliary angle (TCA) of four (superior, nasal, inferior, and temporal) quadrants were measured. Results: The average CPL was 0.513 ± 0.074 mm, and the average CPA was 0.890 ± 0.141 mm2. CPL and CPA tended to be longer and larger in the superior quadrant (p < 0.001) than in the other three quadrants. Average CPL was significantly correlated with AL (r = 0.535, p < 0.001), ACD (r = 0.511, p < 0.001), and LT (r = −0.512, p < 0.001). Intraclass correlation coefficient (ICC) scores were high for CPL (0.979), CPD (0.992), CPA (0.966), CMA (0.963), and CBA (0.951). Conclusions: In healthy Chinese subjects, CPL was greatest in the superior quadrant, followed by the inferior, temporal, and nasal quadrants, and CPA was largest in the superior quadrant, followed by the tempdoral, inferior, and nasal quadrants. Transverse UBM images can be used to measure the anatomy of the ciliary process with relatively good repeatability and reliability.

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Treatment Outcomes of Slow Coagulation Transscleral Cyclophotocoagulation In Pseudophakic Patients with Medically Uncontrolled Glaucoma

Cited by 20 publications

References 27 publications

MicroPulse Transscleral Laser Therapy Demonstrates Similar Efficacy with a Superior and More Favorable Safety Profile Compared to Continuous-Wave Transscleral Cyclophotocoagulation

MicroPulse Transscleral Laser Therapy Demonstrates Similar Efficacy with a Superior and More Favorable Safety Profile Compared to Continuous-Wave Transscleral Cyclophotocoagulation

Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation

Characteristics of the Ciliary Body in Healthy Chinese Subjects Evaluated by Radial and Transverse Imaging of Ultrasound Biometric Microscopy

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