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Clinical science
Primary slow-coagulation transscleral cyclophotocoagulation laser treatment for medically recalcitrant neovascular glaucoma
  1. Mohamed M Khodeiry1,2,
  2. Alison J Lauter1,
  3. Mohamed S Sayed1,
  4. Ying Han3,
  5. Richard K Lee1
  1. 1 Department of Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
  2. 2 Department of Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt
  3. 3 Deparmtent of Ophthalmology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Richard K Lee, Department of Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, FL 33136, USA; RLee{at}med.miami.edu

Abstract

Aims To report treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in patients with neovascular glaucoma (NVG).

Methods A retrospective study including 53 patients (mean age of 69.6±16.6 years and mean follow-up of 12.7±8.9 months) with a diagnosis of NVG and no previous incisional glaucoma or cyclophotocoagulation surgeries. All patients underwent slow-coagulation continuous-wave TSCPC (1250-milliwatt power and 4-second duration).

Primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21 mm Hg with a reduction ≥20% from baseline, no reoperation for glaucoma and no loss of light perception vision. Secondary outcome measures include IOP, glaucoma medications, visual acuity (VA) and complications.

Results IOP decreased from 40.7±8.6 mm Hg preoperatively to 18.4±12.2 mm Hg postoperatively (p<0.001). The preoperative number of glaucoma medications dropped from 3.3±1.1 at baseline to 2.0±1.5 at the last postoperative visit (p<0.001). The cumulative probabilities of success at 12 and 24 months were 71.7% and 64.2 %, respectively. Mean logarithm of the minimum angle of resolution VA was relatively unchanged from 2.27±0.63 to 2.25±0.66 at the last follow-up visit (p=0.618). The most common observed complications were decrease in baseline VA (13.2%) and anterior chamber inflammation (9.4%).

Conclusions Slow-coagulation TSCPC is an effective and relatively safe initial surgical intervention in medically uncontrolled NVG.

  • glaucoma
  • treatment lasers
  • neovascularisation
  • intraocular pressure
  • ciliary body

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/bjophthalmol-2021-319757

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors MMK, AJL, MSS, YH and RKL were responsible for conception and design of the study. MMK, AJL and MSS were responsible for data collection. MMK, AJL and MSS were responsible for data analysis and interpretation. MMK, AJL and RKL were responsible for drafting the article. All authors were responsible for revisions and final approval of the article. RKL is guarantor and responsible for the overall article content.

    • Funding The Bascom Palmer Eye Institute is supported by NIH Centre Core Grant P30EY014801 and a Research to Prevent Blindness Unrestricted Grant. RKL is supported by the Walter G Ross Foundation. This work was partly supported by the Camiener Foundation Glaucoma Research Fund and the Gutierrez Family Research Fund.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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