Slow-Coagulation Transscleral Cyclophotocoagulation in Pseudoexfoliation Glaucoma

Purpose: To evaluate the outcomes of slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) in pseudoexfoliation glaucoma (PXG).

Methods: A single-center, retrospective non-comparative study including consecutive patients with medically uncontrolled PXG who underwent SC-TSCPC (1250-milliwatt power and 4-second duration). The primary outcome measure was surgical success (defined as intraocular pressure (IOP) between 6 - 21 mmHg with ≥20% reduction compared to baseline and no need for further glaucoma surgeries or development of vision-threatening complications). Success was considered qualified when achieved with additional glaucoma medications and complete when achieved without additional glaucoma medications. The secondary outcomes included IOP, glaucoma medication numbers, visual acuity, and postoperative complications at 1 and 2 years after laser treatment.

Results: This study included 48 eyes of 48 patients. The median age of study participants was 87.5 years, with a median follow-up duration of 24.0 months. The qualified success for a single SC-TCPC treatment at 1 and 2 years was 58.3% and 47.9%, respectively. Cumulative qualified success (>1 SC-TSCPC) was 64.6% at 1 year and 56.2% at 2 years. Complete surgical success after a single SC-TSCPC was 45.8% at 1 year and 33.3% at 2 years, increased to 50.0% at 1 year and 39.6% at 2 years after >1 SC-TSCPC. After SC-TSCPC treatment, the mean IOP decreased from 29.2±10.3 mmHg on 3.7±1.0 medications pre-treatment to 14.3±6.43 mmHg on 2.6±1.3 medications at the final follow-up visit (P<0.001). Seven eyes (14.6%) had SC-TSCPC retreatment, and two eyes (4.2%) required incisional glaucoma surgeries. Reported postoperative complications included: decreased visual acuity in 9 (18.8%) eyes, iridocyclitis in 5 (10.4%) eyes, hyphema in 5 (10.4%) eyes, cystoid macular edema in 2 (4.2%) eyes, and transient hypotony in 2 (4.2%) eyes.

Conclusions: SC-TSCPC is an effective, relatively safe, and repeatable surgical treatment option in PXG. Further prospective investigations are suggested to confirm these findings.