scholarly journals Comparison of the safety and efficacy of triple sequential therapy and transscleral cyclophotocoagulation for neovascular glaucoma in the angle-closure stage

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Ying Hong ◽  
Yuntao Hu ◽  
Hongliang Dou ◽  
Changguan Wang ◽  
Chun Zhang ◽  
...  
Keyword(s):  
Sequential Therapy ◽  
Neovascular Glaucoma ◽  
Angle Closure ◽  
Safety And Efficacy ◽  
Transscleral Cyclophotocoagulation

scholarly journals Case report – Acute Corneal Subepithelial Hydrops (ACSH) during Micropulse Transscleral Cyclophotocoagulation (MPTSC)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Poemen P. Chan ◽  
Matthew C.W. Lam ◽  
Nafees Baig
Keyword(s):  
Cataract Extraction ◽  
Neovascular Glaucoma ◽  
Venous Occlusion ◽  
Angle Closure ◽  
Blurred Vision ◽  
Operative Complication ◽  
Primary Angle Closure Glaucoma ◽  
Corneal Epithelial Defect ◽  
Transscleral Cyclophotocoagulation ◽  
Subepithelial Layer

Abstract Background To present an unusual intra-operative complication of micropulse transscleral cyclophotocoagulation (MPTSC). Case presentation A 72-year old Chinese gentleman, who had primary angle closure glaucoma and had received bilateral laser iridotomy, presented with progressive left eye blurred vision (visual acuity of 20/40 OD and 20/200 OS). Examination reviewed left eye central retinal venous occlusion. The intraocular pressure (IOP) was 19 mmHg OS and was on maximally tolerated topical medications. Four weeks later, the left eye was complication by neovascular glaucoma; the IOP was raised to 26 mmHg despite additional oral acetazolamide and remained elevated after pan-retinal photocoagulation as well as cataract extraction by phacoemulsification. MPTSC was performed 8 days after the phacoemulsification. During the procedure, a sudden protrusion was formed on the corneal surface. On-table examination with operating microscope and portable slit-lamp reviewed an intact corneal epithelium with a globular-shaped collection of fluid at the subepithelial layer – acute corneal subepithelial hydrops (ACSH). The anterior chamber was formed and the globe was intact. After approximately 10–15 minutes, the swelling spontaneously ruptured and became a corneal epithelial defect. The defect healed on the tenth day after the event with conservative management. There was no irreversible corneal damage and the patient subsequently underwent a successful second MPTSC of the left eye because of poorly controlled IOP. Conclusion ACSH is a possible intra-operative complication of MPTSC. We have proposed the possible mechanisms of ACSH. It is best to exercise caution when using MPTSC shortly after any incisional intraocular surgery.

scholarly journals Micropulse Transscleral Cyclophotocoagulation: Our Experience

2020 ◽  
Vol 4 (1) ◽  
pp. 1-4
Author(s):  
Syed S. Ahmad ◽  
◽  
Shuaibah A. Ghani ◽  
Ghuncha Khatoon ◽  
Sumera Sagheer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Ciliary Body ◽  
Management Practices ◽  
Neovascular Glaucoma ◽  
Angle Closure ◽  
Safe Procedure ◽  
Small Pilot Study ◽  
Primary Angle Closure Glaucoma ◽  
Micropulse Laser ◽  
Transscleral Cyclophotocoagulation

Introduction Traditionally, ciliary body destruction has been used to treat uncontrolled intraocular pressure (IOP) following maximally tolerable medical therapy. This is due to the large number of complications seen with this procedure. However, recently a new technique of sub-threshold laser or micropulse laser, is able to provide selective destruction of the ciliary body in a controlled manner. This avoids most of the complications seen with other modalities. We have performed a small case descriptive pilot study to assess the effectiveness of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in lowering IOP. Methods This pilot study was conducted on four patients in the age range 55-70-years with intractable glaucoma. Two patients had primary angle closure glaucoma, one-each had steroid-induced glaucoma and neovascular glaucoma. Mean baseline IOP was 32±2.4 mmHg. Mean number of glaucoma medications were 2.5±1.5. All patients underwent 180° MP-TSCPC. Absolute success was defined as IOP<20 mmHg without acetazolamide. Results Following the procedure the patients were followed-up at days 1,7,30 and 90. At the last follow-up of the study, mean IOP was 18.2±1.2 mmHg in all four patients. Mild anterior chamber inflammation was the only complication noted. Mean number of glaucoma medications reduced to 1.5±1.0 following the procedure. Thus, absolute success was achieved in all patients. Conclusion This small pilot study validates other studies which show effectiveness of MP-TSCPC as an efficient and safe procedure to lower IOP. This procedure can be used over a wide variety of cases, though the indications for such procedures are still evolving. More extensive and long-term studies will clarify the position of this procedure in our glaucoma management practices.

scholarly journals Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

2021 ◽  
Author(s):  
Feng Gao ◽  
Jiajian Wang ◽  
Junyi Chen ◽  
Xiaolei Wang ◽  
Yuhong Chen ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Anterior Segment ◽  
Young Patients ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Uncommon Presentation ◽  
Underlying Causes

Abstract Purpose To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. Methods Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts. Results A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan’s syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat’s disease, and neurofibromatosis. Conclusions We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

Early results of micropulse transscleral cyclophotocoagulation for the treatment of glaucoma

2019 ◽  
Vol 30 (4) ◽  
pp. 700-705 ◽  
Author(s):  
Alexander T Nguyen ◽  
Jessica Maslin ◽  
Robert J Noecker
Keyword(s):  
Intraocular Pressure ◽  
Continuous Wave ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Angle Closure ◽  
Secondary Outcome ◽  
Early Results ◽  
Pressure Lowering ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean

Purpose: To describe our clinical experience with the efficacy and safety of micropulse transscleral cyclophotocoagulation as a treatment for glaucoma. Methods: In this retrospective case series, we reviewed the charts of 95 consecutive patients with various glaucoma subtypes who underwent micropulse transscleral cyclophotocoagulation. Patients were offered micropulse transscleral cyclophotocoagulation if they had perimetric glaucoma refractory to intraocular pressure–lowering topical medications and who were poor candidates for traditional filtering surgery. Eligible patients were treated with the Micropulse P3 device (IQ 810 Laser Systems; Iridex, Mountain View, CA, USA) at 2.0–2.5 W for a duration of 90 s per hemisphere at a 31.3% duty cycle. If a retreatment was needed, the power was increased to up to 3.0 W with other parameters remaining the same. Patients were considered successfully treated if their intraocular pressure was lowered by at least 20% compared to their baseline. The main outcome measure was post-operative intraocular pressure; secondary outcome measures included the number of adverse events and complications that occurred with treatment. Results: The glaucoma subtypes treated included primary open-angle glaucoma (n = 51), exfoliation glaucoma (n = 24), chronic angle-closure glaucoma (n = 15), and congenital/juvenile glaucoma (n = 5). The mean pre-operative intraocular pressure was 25.1 ± 5.3 mm Hg and the mean post-operative intraocular pressure at 12 months was 17.5 ± 5.1 mm Hg (p = 0.004). The mean number of intraocular pressure–lowering medications used preoperatively was 3.0 ± 1.1; the mean number of medications used at the 12-month post-operative visit was 1.4 ± 1.0 (p = 0.03). Success with one treatment was achieved in 73 (76.8%) of patients. With multiple treatments, all patients had significant intraocular pressure–lowering compared to baseline. The maximum number of treatments received by any single patient was 5. There were no instances of prolonged intraocular inflammation or long-term hypotony. Conclusion: Micropulse transscleral cyclophotocoagulation appears to be a safe and efficacious treatment for glaucoma. Given its improved safety profile compared to continuous-wave transscleral cyclophotocoagulation, it deserves consideration as a primary procedure.

Results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema

2021 ◽  
pp. 17-21
Author(s):  
L.N. Boriskina ◽  
◽  
A.S. Zotov ◽  
A.S. Balalin ◽  
S.V. Balalin ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Macular Edema ◽  
Neovascular Glaucoma ◽  
Proliferative Retinopathy ◽  
Iol Implantation ◽  
Second Stage ◽  
Corrected Visual Acuity ◽  
Complicated Cataract ◽  
Diabetic Proliferative Retinopathy ◽  
Transscleral Cyclophotocoagulation

Objective. To evaluate the results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema. Material and methods. A retrospective study of the complicated cataract surgery with IOL implantation results was performed in 38 patients (38 eyes) with neovascular glaucoma. The first stage was Lucentis intravitreal injection, then after 2 weeks intraocular pressure (IOP) under combined medical therapy was determined: 1) if IOP was <25 mm Hg, then phacoemulsification was performed; 2) if IOP remained >25 mm Hg, the second stage was transscleral cyclophotocoagulation, and 2 weeks later – cataract phacoemulsification. Results. All patients with neovascular glaucoma had significant increase of the best corrected visual acuity from the initial level on the 1st day, 1- and 3-months post-op. IOP values under medical treatment corresponded to the range of the average statistical norm. There was no recurrence of neovascularization or IOP increase. Conclusion. The application of Lucentis intravitreal injections as well as IOP lowering to the average statistical norm range under medication or laser surgery provide the basis for an effective and safe complicated cataract surgery with IOL implantation in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or post-thrombotic macular edema. Key words: cataract, neovascular glaucoma, phacoemulsification.

scholarly journals The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma

2022 ◽  
Vol 8 ◽  
Author(s):  
Ling Bai ◽  
Yanfen Wang ◽  
Xindi Liu ◽  
Yuping Zheng ◽  
Wenjing Wang ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Neovascular Glaucoma ◽  
Stage Iii ◽  
Safety And Efficacy ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
Pan Retinal Photocoagulation ◽  
Three Stages ◽  
To Receive ◽  
Retinal Photocoagulation

This study investigates the safety and efficacy of conbercept injection through different routes for neovascular glaucoma (NVG) treatment, in which seventy-four patients (81 eyes) with NVG caused by ischemia retinopathy had participated. Patients were divided into three stages according to the progression of NVG and were randomly assigned to receive intracameral or intravitreal conbercept injection. After conbercept injection, patients experienced improved best-corrected visual acuity (BCVA), good intraocular pressure (IOP) control, and neovascularization of Iris (NVI) regression. In stage III, patients required trabeculectomy with mitomycin C plus pan-retinal photocoagulation (PRP) to achieve complete NVI regression. Compared to the intravitreal group, the intracameral group had significantly lower IOP in 2 days in stage III and 1 day in stages I and II after injection, complete NVI regression before PRP in stages I and II, and better NVI regression in stage III. The rates of hyphema after trabeculectomy and malfunction filtering bleb suffering needle bleb revision were lower in the intracameral group, but only the hyphema rate was significantly different. Injections through different routes are all safe. We recommend intravitreal injections for patients in stages I and II, but for stage III, intracameral injection is better, and trabeculectomy with mitomycin C should be conducted within 2 days after injection to maximally reduce the risk of perioperative hyphema.Trial Registration:ClinicalTrials.gov, identifier NCT03154892.

Primary slow-coagulation transscleral cyclophotocoagulation laser treatment for medically recalcitrant neovascular glaucoma

2021 ◽  
pp. bjophthalmol-2021-319757
Author(s):  
Mohamed M Khodeiry ◽  
Alison J Lauter ◽  
Mohamed S Sayed ◽  
Ying Han ◽  
Richard K Lee
Keyword(s):  
Continuous Wave ◽  
Surgical Intervention ◽  
Neovascular Glaucoma ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Slow Coagulation ◽  
Minimum Angle ◽  
Transscleral Cyclophotocoagulation ◽  
Cumulative Probabilities

AimsTo report treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in patients with neovascular glaucoma (NVG).MethodsA retrospective study including 53 patients (mean age of 69.6±16.6 years and mean follow-up of 12.7±8.9 months) with a diagnosis of NVG and no previous incisional glaucoma or cyclophotocoagulation surgeries. All patients underwent slow-coagulation continuous-wave TSCPC (1250-milliwatt power and 4-second duration).Primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21 mm Hg with a reduction ≥20% from baseline, no reoperation for glaucoma and no loss of light perception vision. Secondary outcome measures include IOP, glaucoma medications, visual acuity (VA) and complications.ResultsIOP decreased from 40.7±8.6 mm Hg preoperatively to 18.4±12.2 mm Hg postoperatively (p<0.001). The preoperative number of glaucoma medications dropped from 3.3±1.1 at baseline to 2.0±1.5 at the last postoperative visit (p<0.001). The cumulative probabilities of success at 12 and 24 months were 71.7% and 64.2 %, respectively. Mean logarithm of the minimum angle of resolution VA was relatively unchanged from 2.27±0.63 to 2.25±0.66 at the last follow-up visit (p=0.618). The most common observed complications were decrease in baseline VA (13.2%) and anterior chamber inflammation (9.4%).ConclusionsSlow-coagulation TSCPC is an effective and relatively safe initial surgical intervention in medically uncontrolled NVG.

Сombined (anti-VEGF and laser) treatment for operated secondary refractory neovascular glaucoma

2021 ◽  
pp. 24-26
Author(s):  
A.A. Gamidov ◽  
◽  
Z.V. Surnina ◽  
I.V. Andreeva ◽  
I.A. Velieva ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Antihypertensive Drugs ◽  
Optimal Algorithm ◽  
Sequential Therapy ◽  
Neovascular Glaucoma ◽  
Hypotensive Effect ◽  
Laser Coagulation ◽  
Anti Vegf ◽  
Secondary Refractory

Purpose. To develop an optimal algorithm for the management of patients with operated neovascular uncompensated glaucoma. Material and methods. 2 patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Ranibizumab (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed. Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up. Conclusion. The use of combined laser technologies and anti-VEGF therapy makes it possible to potentiate and prolong the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma. Key words: operated neovascular glaucoma, anti-VEGF, combined laser treatment.

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