Researchers from the University of Miami documented that diode laser transscleral cyclophotocoagulation (TSCPC) reduces intraocular pressure (IOP) and glaucoma medication usage. But it comes at a cost.
The study evaluated 33 eyes of 33 patients who underwent TSCPC for uncontrolled IOP, had a pre-treatment best-corrected visual acuity (BCVA) of 20/40 or better and participated in a postoperative follow-up period of at least six months.
The team found that mean IOP was reduced by 48.3%, from 27.1mm Hg at baseline to 13.1mm Hg at the last follow-up, and that 17 patients were using at least one less glaucoma medication as of the last follow-up. The researchers note that the cumulative probability of complete success—measured as having a BCVA loss of less than two lines, a 20% reduction in IOP, no reoperation for glaucoma and an IOP decline of at least 5mm Hg—was 78.8% and 50% at six and 12 months, respectively. They add that the cumulative probability of qualified success (which allows for worse BCVA outcomes) fared better, at 90.1% and 81.3% at six and 12 months, respectively.
However, due to 33% of patients experiencing significant vision loss—a BCVA loss of at least two lines—56.3% suffering from postoperative iritis and 12.5% developing cystoid macular edema, the study concludes that future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine the comparative safety and efficacy of diode laser TSCPC.
|Shah P, Bhakta A, Vanner EA, et al. Safety and efficacy of diode laser transscleral cyclophotocoagulation in eyes with good visual acuity. J Glaucoma. August 14, 2018. [Epub ahead of print].|