Researchers from the University of Miami documented that diode laser transscleral cyclophotocoagulation (TSCPC) reduces intraocular pressure (IOP) and glaucoma medication usage. But it comes at a cost.

The study evaluated 33 eyes of 33 patients who underwent TSCPC for uncontrolled IOP, had a pre-treatment best-corrected visual acuity (BCVA) of 20/40 or better and participated in a postoperative follow-up period of at least six months.

The team found that mean IOP was reduced by 48.3%, from 27.1mm Hg at baseline to 13.1mm Hg at the last follow-up, and that 17 patients were using at least one less glaucoma medication as of the last follow-up. The researchers note that the cumulative probability of complete success—measured as having a BCVA loss of less than two lines, a 20% reduction in IOP, no reoperation for glaucoma and an IOP decline of at least 5mm Hg—was 78.8% and 50% at six and 12 months, respectively. They add that the cumulative probability of qualified success (which allows for worse BCVA outcomes) fared better, at 90.1% and 81.3% at six and 12 months, respectively.

However, due to 33% of patients experiencing significant vision loss—a BCVA loss of at least two lines—56.3% suffering from postoperative iritis and 12.5% developing cystoid macular edema, the study concludes that future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine the comparative safety and efficacy of diode laser TSCPC.

Shah P, Bhakta A, Vanner EA, et al. Safety and efficacy of diode laser transscleral cyclophotocoagulation in eyes with good visual acuity. J Glaucoma. August 14, 2018. [Epub ahead of print].