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Editors Selection IGR 22-1

Surgical Treatment: Slow Transscleral cyclophotocoagulation

Comment by Ziad Khoueir & Youssef Abdelmassih on:

92428 Treatment Outcomes of Slow Coagulation Transscleral Cyclophotocoagulation In Pseudophakic Patients with Medically Uncontrolled Glaucoma, Khodeiry MM; Sheheitli H; Sayed MS et al., American Journal of Ophthalmology, 2021; 229: 90-99

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Khodeiry and colleagues retrospectively evaluated the outcomes of slow coagulation transcleral cyclophotocoagulation (TSCPC) in pseudophakic patients with refractory glaucoma or treatment intolerance as an initial surgical procedure. The intervention was performed under retrobulbar anesthesia. The technique and results of slow coagulation have been covered by the author's team in other papers.^1,2 treatment course, surgical techniques, settings and outcomes were assessed. Main Outcome Measures: The main outcome measures were visual acuity (VA Each eye received 16-20 laser applications spaced one-half the width of the G-Probe footplate apart with a power settings of 1250 mW of 810-nm infrared diode laser and a duration of four seconds. A total of 74 eyes of 74 patients were included. Open-angle glaucoma was the most frequent glaucoma diagnosis. Retreatment was needed in 14.9% of cases and the cumulative probabilities of success were 60.6% and 58.5% at one and two years, respectively. Eyes were divided into the high IOP group with baseline IOP > 21 mmHg and low IOP group with baseline IOP ≤ 21 mmHg. In the high IOP group, IOP and number of glaucoma medications significantly decreased from 32.8 ± 7.5 mmHg and 4.3 ± 0.9 respectively at baseline to 17.7 ± 6.8 mmHg and 3.3 ± 1.2 at last follow-up. The success was 64.9% and 64.9% at 1 and 2 years, respectively. In the low IOP group, IOP and number of glaucoma medications significantly decreased from 17.2 ± 2.9 mmHg and 3.6 ± 0.8 respectively at baseline to 12.9 ± 3.8 mmHg and 3.0 ± 1.4 at last follow-up. The success was 52.0% and 45.5% at one and two years, respectively.

There was a significant decrease in visual acuity of around 0.35 ± 0.65 logMAR and the most frequent cause was macular disease. The most common complication was anterior chamber inflammation occurring in 12% of cases. No cases of hypotony or phthisis bulbi were reported but one eye lost light perception.

slow coagulation TSCPC is a relatively safe procedure with good efficacy as a first line intervention in pseudophakic patients with medically uncontrolled glaucoma

The main limitations of this study are its retrospective nature, a significant proportion of patients lost to follow-up and an underrepresentation of neovascular glaucoma.

In conclusion, slow coagulation TSCPC is a relatively safe procedure with good efficacy as a first line intervention in pseudophakic patients with medically uncontrolled glaucoma. The procedure tends to be more efficient in patients with baseline IOP > 21 mmHg.

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