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Semiconductor diode laser transscleral cyclophotocoagulation versus filtering surgery with Mitomycin-C
L E Pablo1, M L Gómez, M Pueyo
1Department of Ophthalmology, Miguel Servet Hospital, Zaragoza, Spain.
Abstract:
Both filtering surgery with Mitomycin-C and diode laser cyclophotocoagulation have proved to be effective alternatives in cases of glaucoma with poor surgical prognosis. The right eyes of 40 pigmented rabbits were randomly divided into 2 groups: Mitomycin-C group underwent filtering surgery with application of 0.4 mg/ml of Mitomycin-C whereas the diode laser (DL) group received 15 applications of 1.8 J (1800 mW. 1000 ms) distributed in 270 degrees. Mean IOP showed statistical differences in two periods between days 3-13 and 45-60-Mann-Whitney U test -with a higher IOP lowering in the DL group. The comparison of IOP survival curves (Log-Rank test) was not significant p = 0.070809. Ocular hypertension, hyphema and inflammatory signs were higher in the DL group, both in short and long term, but in terms of statistical significance only ocular hypertension showed differences p = 0.00011717-Fisher exact test. Microscopic examination revealed patent sclerostomies in 60% of the MMC group eyes with different grades of fibroblastic proliferation. In the DL group we observed necrosis of the scleral stroma and of the pigmented and unpigmented ciliary epithelium, with signs of thermal coagulation of the ciliary stroma and of the stromal vasculature. We must point out that the treatment with laser has proved to be more effective although both treatments showed very acceptable IOP lowering until 2 months after the surgery.
Insights
Diode laser cyclophotocoagulation demonstrated superior intraocular pressure (IOP) reduction compared to filtering surgery with Mitomycin-C in rabbits. However, the laser group experienced more ocular hypertension and inflammation, despite comparable long-term IOP control.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Surgical Interventions
Background:
- Glaucoma management often requires surgical intervention for cases with poor prognosis.
- Filtering surgery with Mitomycin-C and diode laser cyclophotocoagulation are established alternatives.
- Comparative efficacy and safety data are crucial for treatment selection.
Purpose of the Study:
- To compare the efficacy and safety of diode laser cyclophotocoagulation versus filtering surgery with Mitomycin-C in a rabbit model.
- To evaluate intraocular pressure (IOP) reduction and associated complications.
Main Methods:
- Forty pigmented rabbits underwent either filtering surgery with Mitomycin-C (MMC) or diode laser (DL) cyclophotocoagulation.
- MMC group received 0.4 mg/ml MMC during filtering surgery.
- DL group received 15 applications of 1.8 J at 270 degrees.
Main Results:
- The diode laser group showed statistically significant higher IOP lowering between days 3-13 and 45-60.
- Ocular hypertension, hyphema, and inflammation were more frequent in the DL group (p=0.00011717 for ocular hypertension).
- Microscopic analysis revealed patent sclerostomies in 60% of MMC eyes and scleral necrosis in DL eyes.
Conclusions:
- Diode laser cyclophotocoagulation proved more effective in IOP reduction than Mitomycin-C augmented filtering surgery in this model.
- Both procedures offered acceptable IOP lowering up to two months.
- Increased ocular hypertension and inflammation necessitate careful consideration of diode laser treatment risks.