Transscleral diode cyclophotocoagulation for refractory glaucoma: real-world efficacy and safety

Area of Science:

• Ophthalmology
• Glaucoma Management
• Surgical Interventions

Background:

• Refractory glaucoma presents a significant challenge in intraocular pressure (IOP) management.
• Transscleral diode laser cyclophotocoagulation (TSCPC) is an established treatment option for advanced glaucoma.
• Real-world data is crucial for understanding the efficacy and safety of TSCPC in diverse clinical settings.

Purpose of the Study:

• To evaluate the real-world efficacy and safety of transscleral diode laser cyclophotocoagulation (TSCPC).
• To assess IOP reduction, visual acuity, medication usage, and complications in refractory glaucoma patients.
• To analyze outcomes from a tertiary referral center's clinical data.

Main Methods:

• Retrospective review of 143 patients undergoing primary TSCPC for refractory glaucoma (Dec 2022 - Jan 2024).
• Collected data included IOP, best-corrected visual acuity (BCVA), medication count, and complications.
• Surgical success defined by IOP 6-21 mmHg with ≥20% reduction, with or without medication, excluding severe adverse outcomes.

Main Results:

• Mean IOP significantly decreased from 35.9 mmHg preoperatively to 16.2 mmHg at 12 months (p<0.001).
• Overall surgical success was 65.8% (16.8% complete, 49.0% qualified); mean medication use dropped from 2.8 to 1.5.
• Complications occurred in 10.9% of eyes, primarily mild and transient; no persistent hypotony or phthisis bulbi observed.

Conclusions:

• TSCPC demonstrated significant IOP reduction and an acceptable safety profile over 12 months in a real-world setting.
• The procedure was effective even in a high proportion of neovascular glaucoma cases, without sight-threatening complications.
• Longer-term studies are warranted to confirm the durability and long-term safety of TSCPC outcomes.