Double-Arc Slow-Coagulation Transscleral Cyclophotocoagulation Laser Protocol

Purpose

To report the short-term effectiveness and safety results of a new continuous laser protocol, double-arc slow-coagulation transscleral cyclophotocoagulation (DA-TSCPC).

Design

Multicenter retrospective study.

Participants

We reviewed the clinical records of refractory glaucoma patients that had undergone DA-TSCPC between April 2019 and July 2022, with at least 12 months of postoperative follow-up.

Methods

The technique was standardized (energy: 1400 mW; duration: 4 seconds; 28 applications). The applications were divided into 2 rows (upper and lower arcs). For each arc, 7 spots were applied over the ciliary body shadow and 7 spots 1.5 mm behind, sparing the 3 and 9 o’clock meridians.

Main Outcome Measures

Success was defined as postoperative intraocular pressure (IOP) between 6 and 18 mmHg and an IOP reduction of 30% (without oral acetazolamide). For eyes with no light perception (NLP), in which treatment goal was pain relief, success was defined as a 30% IOP reduction and no pain (without oral acetazolamide). Patients were divided according to visual acuity: ≥ 20/400 (group 1) and < 20/400 (group 2).

Results

Ninety eyes of 90 patients (mean age: 61 ± 15 years) were included. Glaucoma diagnosis frequency was: neovascular glaucoma (38%), open-angle glaucoma (28%), silicone oil secondary glaucoma (17%), and others (18%). Overall, the mean IOP was significantly reduced from 35 ± 12 to 22 ± 14 mmHg (P < 0.01) at the last follow-up visit. The number of hypotensive eye drops (2.6 ± 1–2.3 ± 1; P = 0.02) and the use of oral acetazolamide (61%–11%; P < 0.01) were also reduced. Kaplan–Meier survival analysis revealed a global success rate of 65.6% after 12 months. A higher success rate was found for group 1 (78.6%) compared to group 2 (59.6%; P = 0.047; logrank test). The main complications observed were corneal ulcer (4.4%), macular edema (1.1%), and hyphema (1.1%). Among the 26 eyes with NLP, 65% achieved success criteria at 12 months and 2 (7.7%) developed phthisis.

Conclusions

Based on these initial retrospective data, the DA-TSCPC protocol seems to be an alternative for refractory glaucoma management, presenting significant IOP reduction and a good safety profile after 1 year. Better outcomes were observed in eyes with less severe functional damage.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.