Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty

doi:10.1016/S0161-6420(01)00767-9

Ophthalmology

Volume 108, Issue 11, November 2001, Pages 1986-1991

Presented in part at the Oxford Ophthalmological Congress, Oxford, England, July 1998.

https://doi.org/10.1016/S0161-6420(01)00767-9 Get rights and content

Abstract

Objective

This study analyzes the results of intraocular pressure (IOP) reduction by contact diode cycloablation (cyclodiode) in cases of refractory glaucoma after penetrating keratoplasty.

Design

Retrospective noncomparative, interventional case series.

Participants

Twenty-eight eyes in 28 patients attending the Moorfields Eye Hospital.

Intervention

Cyclodiode (40 applications × 1.5 W × 1.5 seconds over 270–300°) was used to control the IOP in refractory glaucoma after penetrating keratoplasty.

Main outcome measures

Postoperative IOP, graft status, visual acuity, and number of antiglaucoma medications were recorded after cyclodiode treatment.

Results

Cyclodiode resulted in a reduction of IOP from a median of 33 mmHg (interquartile range [28, 40.5]) to a median of 15 mmHg (interquartile range [12, 20.5]). Most patients had a significant lowering in IOP with a median reduction of 16 mmHg (interquartile range [12, 25]; P < 0.0001). IOPs of 6 to 21 mmHg were achieved in 22 patients (79%). Sixteen patients (57%) required more than one treatment with cyclodiode to control the IOP, with three patients (11%) requiring three treatments and two patients (7%) requiring four treatments. Visual acuity improved (> two Snellen lines of acuity) in three patients (11%) and remained the same (± one Snellen line) in 17 patients (61%). The mean number of antiglaucoma medications before cycloablation was 2.6 and was 1.8 after treatment (P < 0.001). Of the 19 patients (68%) with originally clear grafts, three grafts (16%) developed opacification. One patient (4%), with a history of nanophthalmos and recurrent uveal effusion, had delayed hypotony (IOP < 6 mmHg) occurring 46 months after the diode treatment. All patients had at least 6 months follow-up.

Conclusions

These patients have often undergone multiple previous complicated ocular interventions and are often not suitable for filtration surgery. Reduction of IOP with maintenance of visual acuity and a good safety profile was achieved in most patients in this study but may require multiple treatments. We propose cyclodiode as an effective treatment for many patients in the management of refractory glaucoma after penetrating keratoplasty.

Section snippets

Patients and methods

Consecutive patients under one surgeon (PTK) who underwent contact cyclodiode for refractory glaucoma after penetrating keratoplasty at Moorfields Eye Hospital between 1996 and 1998 had their case notes reviewed. Ethics committee approval was not required for this study. Information was collected on age, gender, date of penetrating keratoplasty, reason for penetrating keratoplasty, IOP, visual acuity, lens status, previous surgery, number of treatments necessary, time from penetrating

Results

Twenty-eight eyes of 28 patients (18 male, 10 female) were treated with cyclodiode for refractory glaucoma after complicated penetrating keratoplasty (Table 1). Median age was 60.5 years (range, 9–90). Twenty-four patients (86%) were Caucasian, one patient (4%; patient 21) was African Caribbean, and three patients (11%; patients 5, 12, and 23) were Asian. In six patients (21%), the eye undergoing treatment was the only effective eye for vision. All patients had at least 6 months follow-up, with

Discussion

The incidence of glaucoma after penetrating keratoplasty varies between studies depending on techniques and patient population, with recent studies indicating an incidence of 11% to 18%.10, 11, 12 In the short term, it can be caused by angle compression, inflammation, pupil-block, steroid response, hemorrhage, and pigment dispersion.2 In the longer term, glaucoma is due to chronic angle closure from the formation of peripheral anterior synechiae, steroids, and chronic inflammation. Associated

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Cited by (41)

Cyclodestructive Techniques
2015, Glaucoma: Second Edition
Post-penetrating keratoplasty glaucoma management: Report of 73 cases
2014, Journal Francais d'Ophtalmologie
L’hypertonie oculaire post-kératoplastie transfixiante (KPT) est une menace réelle pour le pronostic visuel. Les moyens thérapeutiques sont multiples mais l’absence d’un arbre décisionnel bien codifié et les résultats variables des différentes techniques rendent la prise en charge très difficile.
Étude rétrospective, portant sur 73 yeux ayant bénéficié d’une KPT. Les patients qui présentent une hypertonie oculaire sont mis initialement sous traitement médical et en cas d’échec, ils bénéficient d’un traitement chirurgical à type de trabéculectomie ou d’implant de drainage. Pour chaque traitement, nous avons surveillé : le tonus oculaire (TO) par tonomètre à applanation, les effets indésirables ainsi que la survenue d’un échec de la greffe.
Le traitement médical utilisé en première intention était un bêtabloquant. Il a permis le contrôle du TO dans 80,6 % des cas. La valve d’Ahmed a été utilisée pour deux patients avec succès sans opacification du greffon. La trabéculectomie a été préconisée pour cinq patients. Nous avons noté la survenue d’un rejet immunologique chez trois patients au bout de 6 à 9 mois. Nous avons aussi constaté que l’hypertonie tardive était liée à l’échec anatomique de la greffe, et ce indépendamment des autres facteurs préopératoires.
Le traitement médical reste le traitement de première intention en cas d’hypertonie après KPT mais il n’est pas rare d’avoir recours à la chirurgie. La trabéculectomie reste de pratique courante et donne de bons résultats avec un risque de rejet moins important en association à la mitomycine C. La mise en place de dispositifs de drainage devient une alternative fiable à la trabéculectomie avec de bons résultats post-opératoires. Les techniques de cyclodestruction, elles, sont réservées aux échecs de la chirurgie avec altération importante de l’acuité visuelle.
To report our experience in the therapeutic management of post-penetrating keratoplasty glaucoma.
Post-penetrating keratoplasty (PK) glaucoma is a true threat to visual prognosis. Therapeutic modalities are many, but the absence of a well-defined decision tree and the variable results of the various techniques renders management very difficult.
This is a retrospective study including 73 eyes of 71 patients undergoing a penetrating keratoplasty. Patients who developed post-operative ocular hypertension were treated first with eye drops. In the case of failure, surgical procedures were recommended including trabeculectomy or glaucoma drainage devices. The intraocular pressure (IOP) assessed with applanation tonometer, side effects and graft failure were monitored.
The first medical treatment used for all patients was a betablocker, which allowed control of intraocular pressure in 80.6 % of eyes. Ahmed glaucoma valve was used in two cases with success and without graft failure. Trabeculectomy was necessary for five patients, three of whom developed immunological graft rejection within 6 to 9 months. We also observed that late ocular hypertension was statistically related to anatomic graft failure, independently of other preoperative factors.
Although hypotensive medication is still the first treatment for ocular hypertension after penetrating keratoplasty, a surgical procedure is sometimes required. Glaucoma drainage devices and trabeculectomy are widely practiced, leading to good outcomes, with the risk of rejection lower in cases involving mitomycin C. Cyclodestructive procedures should be reserved for surgical failures with significant visual loss.
HSV-1 in a case of intractable glaucoma with rapid progress of cataract after transscleral cyclophotocoagulation
2011, Taiwan Journal of Ophthalmology
Citation Excerpt :
The number of pigmented KPs decreased, and IOP remained around 10 mmHg without any anti-glaucomatous agents during one year of follow-up. TSCPC is a well-established and effective method of cyclodestruction for glaucoma after PK.1 Most common complications, including anterior chamber reaction, IOP spikes and conjunctival burns, are mild and transient and do not influence the success of the glaucoma treatment.2
A 22-year-old female patient received penetrating keratoplasty (PK) of her right eye for ocular rosacea complicated with corneal perforation. Intraocular pressure (IOP) fluctuated and could not be well controlled by full antiglaucomatous agents after surgery. Therefore transscleral diode laser cyclophotocoagulation (TSCPC) was performed for the intractable glaucoma one year after PK. Unfortunately, acute cataract formation was noted 50 days after the laser treatment. Pigmented keratic precipitates (KPs) developed and IOP rose subsequently. Cataract extraction with intraocular lens implantation combined with trabeculectomy was performed 3 months later. Polymerase chain reaction (PCR) tests of the aqueous humor to detect cytomegalovirus (CMV) and herpes simplex virus (HSV) were negative. However, HSV type I DNA was detected in the lenticular material and excised trabecular tissue. Trabeculitis caused by herpetic infection could be the reason of fluctuated and intractable IOP elevation. The virus hidden in the intraocular tissue could be reactivated by TSCPC and result in cataract formation. Therefore, performing TSCPC in a phakic eye with atypical IOP presentation should be undertaken with caution.
Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation
2023, European Journal of Ophthalmology
Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure
2023, Journal of Current Glaucoma Practice
Surgical management of glaucoma following different keratoplasty techniques
2022, International Ophthalmology

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^☆: This work has been undertaken by the authors who receive support in part from the NHS Executive, London, England and from the International Glaucoma Association, London, England. The views expressed in this publication are those of the authors and not necessarily of the NHS Executive.

¹: The authors have no propriety interest in any of the materials used in this study.

View full text

Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty1☆,

Abstract

Objective

Design

Participants

Intervention

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Comparison of neodymiumyttrium aluminum garnet and diode transscleral cyclophotocoagulation and cyclocryotherapy

Invest Ophthalmol Vis Sci

NeodymiumYAG laser transscleral cyclophotocoagulation for glaucoma after penetrating keratoplasty

Ophthalmic Surg

Transscleral YAG cyclocoagulation of the ciliary body for persistently high intraocular pressure following penetrating keratoplasty

Cornea

“Cyclodiode.” Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma

Ophthalmology

Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty¹☆,