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Safety and Efficacy of Diode Laser Transscleral Cyclophotocoagulation in Eyes With Good Visual Acuity

Shah, Parth, DO; Bhakta, Amitabha, PhD; Vanner, Elizabeth A., PhD; Kishor, Krishna S., MD; Greenfield, David S., MD; Maharaj, Arindel S.R., MD, PhD

doi: 10.1097/IJG.0000000000001057
Original Studies

Background/Aims: The main aim of this study was to evaluate the safety and efficacy of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with good visual acuity.

Patients and Methods: A retrospective chart review identified patients who underwent TSCPC for uncontrolled intraocular pressure (IOP) from 2014 to 2016. Enrollment criteria included pretreatment best-corrected visual acuity (BCVA) of 20 of 40 or better, and a minimum of 6 months of postoperative follow-up.

Results: Thirty-three eyes of 33 patients(mean age, 72.1±16.0 y) were enrolled (mean follow-up 12.6±6.1 mo). The mean (SD) IOP was reduced 48.3% from 27.1 mm Hg (7.8) at baseline to 13.1 mm Hg (4.2) at last follow-up. Reduction of ≥1 glaucoma medications was achieved in 17 eyes (51.5%) at last follow-up. The cumulative probability of complete success (BCVA loss <2 Snelling lines, 20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 78.8% and 50% at months 6 and 12, respectively. The cumulative probability of qualified success (BCVA≥2 lines with ≥20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 90.1% and 81.3% at month 6 and 1 year, respectively. Significant vision loss, defined as BCVA≥2 lines, occurred in 33% of patients. The most common complications were postoperative iritic (56.3%) and cystoid macular edema (12.5%).

Conclusions: TSCPC demonstrates a strong reduction in IOP and glaucoma medication use. However, with significant vision loss in 33% of patients, future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine comparative safety and efficacy.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, FL

Supported by: NIH Center Core Grant P30EY01801, Research to Prevent Blindness Unrestricted Grant.

Disclosure: D.S.G. serves as a consultant to Aerie Pharmaceuticals, Alcon, Allergan, Bausch+Lomb, and Quark Pharmaceuticals. K.S.K. serves as a consultant to Glaukos and Allergan. The remaining authors declare no conflict of interest.

Reprints: Arindel S.R. Maharaj, MD, PhD, Bascom Palmer Eye Institute, University of Miami, 7101 Fairway Avenue, Palm Beach Gardens, FL 33418 (e-mail: a.maharaj1@med.miami.edu).

Received April 26, 2018

Accepted August 5, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.