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Glaucoma Dialogue IGR 12-3
Comments
Comment by Fabian Lerner on:
26370 Transscleral diode laser cycloablation in patients with good vision, Rotchford AP; Jayasawal R; Madhusudhan S et al., British Journal of Ophthalmology, 2010; 94: 1180-1183
See also comment(s) by Ravi Thomas • Keith Barton • Kuldev Singh • Paul Palmberg • Tarek Shaarawy & Shibal Bhartiya • Stephen Vernon & Rotchfold & Anthony King •Rotchford et al. report their results with the use of transcleral cyclotherapy with diode laser (CPC) in patients with good visual acuity. CPC has been traditionally indicated to lower the IOP in patients with a failed incisional procedure, or with a high probability of failure; and a poor visual acuity.1 Good visual acuity retention was also reported with this technique by Ansari and Gandhewar.2 Limitations to the current study include a small number of eyes, the lack of a control group and being retrospective. It would be interesting to know how many patients were lost during the follow-up period, as well as the results stratified by follow-up time.
Although the primary outcome variable was a loss of two or more Snellen lines of best corrected VA during follow-up (which happened in 30.6% of the eyes), 63.2% had a recorded lost of one or more line of VA. In the discussion, the authors compared their results in terms of visual acuity loss with those of the TVT study.3 However, the TVT study had a prospective comparative design, vs. the present cyclotherapy study being a retrospective non-comparative analysis. Egbert et al. reported few serious complications in a prospective study using cyclodiode treatment as a primary surgical procedure with a mean follow-up of 13 months.4
A prospective randomized study comparing cyclodiode therapy with filtering and/or glaucoma drainage devices procedures would be appropriate to ascertain the role of cyclotherapy in the management of glaucomatous eyes with good visual acuity
The studied population included refractory glaucomas with different diagnoses, and many with previous procedures. Traditional treatments for refractory glaucomas needing intervention include antimetabolite- augmented filtering surgery and glaucoma drainage devices procedures, particularly in eyes retaining good vision. The authors of the present paper suggest the use of cyclodiode therapy in difficult glaucomatous eyes with good vision. A prospective randomized study comparing cyclodiode therapy with filtering and/or glaucoma drainage devices procedures would be appropriate to ascertain the role of cyclotherapy in the management of glaucomatous eyes with good visual acuity.
References
- Pastor SA, Singh K, Lee DA, et al. Cyclophotocoagulation. A report by the American Academy of Ophthalmology. Ophthalmology 2001;108:21-30-2138.
- Ansari E, Gandhewar J. Long-term efficacy and visual acuity following transscleral Diode laser photocoagulation in cases of refractory and non-refractory glaucoma. Eye 2007;21:936-940.
- Gedde SJ, Schiffman JC, Feuer WJ, et al. Three-year follow-up of the tube versus trabeculectomy study. Am J Ophthalmol 2009;148:670-684.
- Egbert PE, Fiadoyor S, Budenz DL, et al. Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for primary open-angle glaucoma. Arch Ophthalmol 2001;119:345-350.
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