Comparison of the diurnal efficacy and safety of cyclocryocoagulation and cyclophotocoagulation in patients with refract
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ORIGINAL PAPER
Comparison of the diurnal efficacy and safety of cyclocryocoagulation and cyclophotocoagulation in patients with refractory glaucoma Soeren Waibel
. Robert Herber . Lutz E. Pillunat . Karin R. Pillunat
Received: 7 February 2020 / Accepted: 25 April 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To compare the diurnal IOP-lowering efficacy and safety of cyclocryocoagulation (CCC) and cyclophotocoagulation (CPC) in patients with refractory glaucoma. Methods Forty eyes of 40 Caucasian patients with advanced primary or secondary glaucoma with only tunnel vision left were included in this retrospective, comparative interventional case series. Twenty eyes treated with CCC were compared with 20 eyes treated with CPC. Primary endpoint was the reduction of 24 h mean diurnal intraocular pressure (IOP; mean of 6 measurements), peak IOP and diurnal IOP fluctuations 3 and 6 months post-treatment. Secondary outcomes were the occurrence of postoperative complications and the identification of factors influencing the postoperative IOP reduction. Results In the CCC group (mean age 70.6 ± 13.4 years), mean diurnal IOP was significantly reduced from 20.0 ± 4.5 mmHg to 14.7 ± 2.5 (p \ 0.001) at 3 months and 13.9 ± 3.34 mmHg at 6-month follow-up (p \ 0.001). In the CPC group (mean age 74.9 ± 9.0 years), mean diurnal IOP significantly decreased from 18.2 ± 3.1 mmHg to
13.2 ± 2.2 (p \ 0.001) at 3 months and 13.1 ± 2.6 mmHg (p \ 0.001) at 6 months. At 6 months, 75% of the CCC and 63% of the CPC group had mean diurnal IOP reductions of 20% or more. The most frequent complication (25%) was a transient IOP increase during the first days after CCC. A higher preoperative mean diurnal IOP was recognized as the only factor influencing the postoperative IOP reduction after CCC and CPC. Conclusions Both cyclodestructive methods seem to be reasonably safe and effective in lowering 24 h mean diurnal IOP in the perspective of 6 months in patients with refractory glaucoma. The IOP-lowering effect after CCC was better but not statistically significantly different compared to CPC. A higher rate of complications was observed in the CCC group, however. Keywords Refractory glaucoma Cyclocryocoagulation Cyclophotocoagulation Intraocular pressure
Introduction S. Waibel (&) R. Herber L. E. Pillunat K. R. Pillunat Department of Ophthalmology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany e-mail: [email protected]
Glaucoma is one of the most common causes of blindness [1]. Despite the medical advance in its treatment, chronic open-angle glaucoma accounts for 12% of blindness worldwide [2]. Intraocular pressure
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(IOP) reduction with topical or systemic medications, laser treatment and surgery are the most important therapeutic approaches [3]. The treatment of refractory glaucoma is a difficult challenge. Often anti-glaucomatous medication is not effective enough, that surgery
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