Micropulse Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma: Short-Term Efficacy, Safety, and Impact of Surgical History on Outcomes

Giancarlo A Garcia; Christine V Nguyen; Aleksandr Yelenskiy; Goichi Akiyama; Brett McKnight; Vikas Chopra; Kenneth Lu; Alex Huang; James C H Tan; Brian A Francis

doi:10.1016/j.ogla.2019.08.009

Micropulse Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma: Short-Term Efficacy, Safety, and Impact of Surgical History on Outcomes

Ophthalmol Glaucoma. 2019 Nov-Dec;2(6):402-412. doi: 10.1016/j.ogla.2019.08.009. Epub 2019 Sep 10.

Affiliations

¹ Doheny Eye Institute, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California; Byers Eye Institute, Stanford University, Palo Alto, California.
² Doheny Eye Institute, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California.
³ Doheny Eye Institute, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California. Electronic address: [email protected].

PMID: 32672572
DOI: 10.1016/j.ogla.2019.08.009

Abstract

Purpose: To assess the short-term efficacy and safety of micropulse transscleral diode laser cyclophotocoagulation (MP-TSCPC) in the management of refractory glaucoma and to compare outcomes based on prior glaucoma surgeries.

Design: Retrospective analysis.

Participants: Patients with refractory glaucoma who underwent MP-TSCPC at a single institution by 1 of 4 surgeons.

Methods: Chart review of cases of MP-TSCPC using the Iridex Cyclo G6 (Mountain View, CA) laser with standard parameters and laser duration at the discretion of each treating physician.

Main outcome measures: Probability of postoperative success was estimated by the Kaplan-Meier method. Success parameters included intraocular pressure (IOP) 6 to 21 mmHg with or without topical antihypertensive therapy, 20% or more IOP reduction from baseline for any 2 consecutive visits after 3 postoperative months, and no subsequent glaucoma surgery.

Results: One hundred sixteen eyes of 116 patients (mean age, 65.8±16.9 years) were included. Baseline IOP was 22.2±7.9 mmHg, and mean postoperative follow-up time was 6.3±3.4 months (range, 3-12 months.) Postoperative IOP at the final follow up was 15.3±6.6 mmHg (P < 0.01), corresponding to a reduction of approximately 6.9 mmHg (31.1%). Most eyes (66.4%) underwent at least 6 months of follow-up. Short-term probability of success was 93.1% at 3 months and 74.3% at 6 months. Eyes that had undergone prior traditional glaucoma surgery (trabeculectomy, tube shunt, excessive pressure-regulating shunt system miniature glaucoma shunt [Alcon, Fort Worth, TX], or a combination thereof) demonstrated a higher probability of success (67.6%) compared with eyes that had not (41.4%; P = 0.014). The most common complications were decline in best-corrected visual acuity (7.8%) and hypotony (1.7%).

Conclusions: Micropulse transscleral diode laser cyclophotocoagulation has a significant short-term ocular hypotensive effect and favorable safety profile in eyes with refractory glaucoma. The probability of successful outcome was greater in eyes that had undergone prior traditional glaucoma surgery.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Ciliary Body / surgery*
Female
Glaucoma, Open-Angle / physiopathology
Glaucoma, Open-Angle / surgery*
Humans
Intraocular Pressure / physiology*
Laser Coagulation / methods
Lasers, Semiconductor / therapeutic use*
Male
Middle Aged
Ophthalmologic Surgical Procedures / methods*
Retrospective Studies
Treatment Outcome
Visual Acuity*
Young Adult