Outcome of Transscleral Cyclophotocoagulation in refractory glaucoma, a retrospective study

Background:

Transscleral Cyclophotocoagulation (TSCPC)is a cyclodestructive procedure used to control elevated Intra Ocular Pressure(IOP) in refractory glaucoma. Recent literature suggests thatcyclophotocoagulation is increasingly performed as the primary surgery forvarious types and stages of glaucoma, even in patients with good vision.

We set out to analyzeefficacy and safety of TSCPC in refractory glaucoma at our hospital.

Methods:

Data was collected retrospectively from patients whounderwent TSCPC at our hospital between January 2013 and August 2015. Allpatients were symptomatic on maximal medical therapy. Primary outcome measure was reduction in IOP and thesecondary outcome measures were relief of symptoms and incidence ofcomplications.

Results:

42 patientsunderwent TSCPC of which 27 were included for analysis. 16men and 11women with mean age 61.81±12.98years and visual acuity rangingfrom 6/24 to no perception of light were included.

MeanIOP decreased from 46.04±8.6 mmHg (range:26-58 mmHg) pre-procedure to 16.7±13.44 mmHg (p<0.001) at last follow up. Completesuccess was achieved in 22.2%, qualified success in 18.5%, 29.6% eyes hadhypotony and 29.6% failed. Mean glaucoma medications decreased from 3.15±1.30to 0.89±1.16 (p<0.001). Patients were asymptomatic; complications werephthisis and vitreous hemorrhage which resolved (one case each).

Conclusion:

Transscleralcyclophotocoagulation is a simple, safe, cost effective method of controllingintra ocular pressures in refractory glaucoma where other methods have highrisk of failure. It is repeatable, may not be restricted to eyes with poorvision potential and a symptom free patient is often the end result.