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 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 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.

Micropulse transscleral cyclophotocoagulation in glaucoma treatment. Preliminary results

2021 ◽  
pp. 48-51
Author(s):  
O.Y. Kukleva ◽  
◽  
K.P. Zhukov ◽  
A.K. Drakon ◽  
D.D. Dement'ev ◽  
...  
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Neovascular Glaucoma ◽  
Open Angle ◽  
Refractory Glaucoma ◽  
Preliminary Results ◽  
Average Decrease ◽  
Micropulse Laser ◽  
Transscleral Cyclophotocoagulation

Objective. To evaluate the preliminary results after micropulse cyclophotocoagulation in patients with primary open-angle refractory glaucoma (POAG) and neovascular glaucoma. Methods. Retrospective study of adult patients with glaucoma, with at least 6 months follow-up after the only one session of micropulse laser therapy. The study included 16 patients, 17 eyes with refractory primary open-angle glaucoma (POAG) and neovascular glaucoma. Follow up period was 6 months. The same surgical technique was used in all cases. The wavelength of the laser beam was 810 nm, the total exposure was 160 s, the energy was 2000 mJ, 31,3% of active cycle, the pulse duration was 0.5 ms, the period was 1.1 ms. Results. The average decrease in IOP was 26.6%. No complications identified Conclusions: micropulse transscleral cyclophotocoagulation has been shown to be safe and effective in lowering IOP in patients with refractory glaucoma. However, further study of this method is required. Key words: micrоpulse transscleral cyclophotocoagulation, glaucoma, intraocular pressure.

scholarly journals Our Experience With Micropulse Cyclophotocoagulation in the Therapy Of Glaucoma

2020 ◽  
Vol 76 (1) ◽  
pp. 29-34
Author(s):  
Elena Nutterová ◽  
Šárka Pitrová ◽  
Ján Lešták
Keyword(s):  
Intraocular Pressure ◽  
Laser Energy ◽  
Open Angle Glaucoma ◽  
Neovascular Glaucoma ◽  
Normal Tension Glaucoma ◽  
Angle Closure ◽  
Pigmentary Glaucoma ◽  
Laser Iridotomy ◽  
Primary Angle Closure Glaucoma ◽  
Retrospective Assessment

The objective of this study was a retrospective assessment of two-year experience with micropulse cyclophotocoagulation (MP CPC) in the therapy of various types of glaucoma. Material and method: The cohort of patients consisted of 47 people, out of which 16 men and 31 women. An average age of males was 58.9 years (the range from 35 to 78 years), and an average age of females was 64.7 years (the range from 33 to 86 years). Both eyes were treated in three patients, and therefore the total number of assessed eyes was 50. Patients who underwent the therapy were in different stages of glaucoma disease, with various types of primary and secondary glaucoma. Most of the patients were those with primary open angle glaucoma (POAG): 26 patients, followed by patients with secondary pseudoexfoliative glaucoma (PEXG): 9 patients; diagnoses of the remaining patients: 4 patients – secondary pigmentary glaucoma (PG), 3 patients - primary angle closure glaucoma (PACG), 2 patients normal tension glaucoma (NTG), 3 patients - Posner-Schlossman syndrome, 1 patient - Cogan-Reese syndrome, 1 patient - neovascular glaucoma and 1 patient – secondary traumatic glaucoma. On the operated eye prior to the surgery 3 patients underwent laser iridotomy, 4 patients trabeculectomy, 4 patients EX-PRESS® implant, 3 patients EX-PRESS® implant and trabeculectomy and 1 patient transscleral cyclophotocoagulation. During surgery we opted for from 2,000 to 2,250 mW infrared laser with 810 nm wavelength which uses a micropulse system of laser energy emission. For the procedure we used a new MP3 application probe. 30% drop in intraocular pressure (IOP) compared to the baseline IOP values was set as a success. Results: Our results correlated with the most of available studies when we achieved drop in the values of intraocular pressure by the minimum of 30% in 53.4% of the eyes. The effect of therapy failed in 9 eyes (18%) where we subsequently selected a different therapeutic procedure. Conclusion: MP CPC is a non-incisional laser treatment with minimum complications. It is characterized by a high safety profile and predictability of results. In our study we achieved drop in the values of intraocular pressure by the minimum of 30% in 53.4% of treated eyes. Its use is not limited by the type of glaucoma disease. In the event of insufficient effect, it may be repeated.

scholarly journals Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

2021 ◽  
Vol 14 (6) ◽  
pp. 931-935
Author(s):  
Dan Calugaru ◽  
Keyword(s):  
Intraocular Pressure ◽  
Ocular Hypertension ◽  
Neovascular Glaucoma ◽  
Venous Occlusion ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Causal Connection ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Retinal Vein Occlusions

Intraocular pressure (IOP) modifications in patients with acute central/hemicentral retinal vein occlusions (RVOs) consist in IOP reductions and increases. The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor, that increases gradually until 3mo after the venous occlusion onset, and then finally disappears after month 4th. The IOP increases lead to the ocular hypertension and glaucoma. The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups: 1) the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis; 2) the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance (ocular hypertension, primary angle-closure, primary angle-closure glaucoma, and open angle glaucomas); and 3) the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations, lacking a causal connection between the 2 conditions.

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