Study investigates predictors of success for diode laser cyclophotocoagulation in glaucoma
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Higher baseline IOP and a history of cataract extraction were found to be predictors of success in a cohort of patients with glaucoma undergoing micropulse transscleral diode laser photocoagulation.
Successful cases maintained stable IOP in the long term, according to a poster presented at the virtual Association for Research in Vision and Ophthalmology meeting.
Similar to continuous wave cyclophotocoagulation, micropulse transscleral diode laser cyclophotocoagulation causes ciliary body destruction to reduce aqueous production and lower IOP but with fewer complications, and it retains the benefit of being a non-incisional procedure, James A. David, MD, said.
“It is a relatively new procedure. Therefore, there have been limited data from few patients, few sites and few surgeons. Reproducibility, long-term outcomes and which patients will respond to the treatment are still questioned,” he said.
To identify predictors of treatment success and to determine success and complication rates, a retrospective chart review study was performed on 139 patients with glaucoma treated at multiple sites from January 2016 to April 2019. Multiple variables were analyzed, including age, gender, race, systemic conditions, treatment modalities as well as glaucoma type, pretreatment medications and surgical interventions. Outcome measures included IOP, number of medications and complication rates up to 39 months. Success of treatment was established as 20% IOP reduction or achievement of IOP between 10 mm Hg and 21 mm Hg.
“Significant IOP decrease from baseline was obtained for all subtypes of glaucoma. At 1 year, success rate was 76%. The only significant predictors of success were a higher baseline IOP and a history of cataract extraction. Multivariate analysis showed that no combination of variables was consistently predictive of treatment success,” David said.
Complications were mostly transient. The most frequent were persistent or recurrent iritis, temporary vision loss of undetermined etiology and IOP spike.
“For patients with treatment success, the study exhibited long-term stability for IOP reduction,” David said.
Future directions could include prospective studies with more uniform treatment protocols and glaucoma subtype analysis, he said.
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David JA, et al. Multisurgeon, multisite retrospective study of the influence of multiple variables on outcomes with micropulse transscleral diode laser cyclophotocoagulation. Presented at: Association for Research in Vision and Ophthalmology annual meeting; June 12, 2020 (virtual meeting).
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