Transscleral cyclophotocoagulation (TCP) is a procedure that uses a laser to essentially destroy a part of the ciliary body in the hopes of decreasing aqueous humor secretion and, ultimately, lowering intraocular pressure (IOP).1 Now, a new study shows that the treatment can address refractory acute primary angle-closure when used in conjunction with cataract surgery.1,2

The study included 13 angle closure patients, all of whom underwent emergency TCP. The laser procedure was then followed by cataract surgery. The researchers compared these patients’ IOP, best-correct visual acuity (BCVA) and ultrasound biomicroscopy (UBM) examinations before and after TCP with 13 age- and gender-matched controls who underwent emergency phacotrabeculectomy.

The study group saw a mean IOP decrease from 51.5mm Hg to 16.4mm Hg one day after TCP. Six months later, no significant difference was noted in IOP or BCVA between the study and control groups; however, IOP lowering medications were used by two of the 13 members of the control group and none of the members of the study group. The UBM parameters of anterior chamber depth, angle-opening distance at 500μm and maximum ciliary body thickness increased significantly while the iris-ciliary process distance decreased significantly in the study group after TCP.

“Even without a difference in final BCVA and IOP, the TCP approach has a major logistic advantage as no emergency surgery has to be performed,” the researchers explained.

Liu W, Qin L, Xu C, et al. Transscleral cyclophotocoagulation followed by cataract surgery: a novel protocol to treat refractory acute primary angle closure. BMC Ophthalmol. May 20, 2020. [Epub ahead of print].