Transscleral cyclophotocoagulation for the treatment of refractory neovascular glaucoma

Neovascular glaucoma (NVG) is a secondary glaucoma characterized by the proliferation of fibrovascular tissue in the angle of the anterior chamber and increased intraocular pressure. Purpose. To study the effectiveness of transscleral cyclophotocoagulation (TSCPC) in treating refractory NVG. Materials and methods. Twenty-six patients (26 eyes) with NVG were under our observation and underwent TSCPC due to IOP non-compensation (more than 26 mm Hg) on maximal antihypertensive therapy were followed up. The mean patient age was 66.2 ± 12.1 years. These included 21 cases with NVG associated with PDR and 5 cases with NVG associated with CRVO or BRVO. Pain syndrome and corneal edema were noted in 12 patients, corneal erosion was reported in 6 patients out of these 12, and corneal ulceration was noted in 2 patients out of these 12. A diode laser (IRIDEX IQ) with a G-probe was used for TSCPC. We applied 14–22 laser applications within 270 degrees. The laser energy was from 1250 mW to 1500 mW, and the application duration was 4 s. Results. Before the treatment, the IOP in all patients was 34.54 ± 5.24 mm Hg, and after TSCPC IOP was 19.62 ± 7.38 mm Hg. After 24 months of follow-up, the IOP was 21.35 ± 5.90 mm Hg. The pain disappeared in 9 patients, corneal edema disappeared in 11 patients, and corneal erosions and ulcers epithelialized in all 8 patients. The number of IOP-lowering medications, used by all patients before treatment averaged 2.69 ± 1.12, and after treatment – 1.08 ± 0.84. Conclusions. TSCPC is an effective method of treating refractory NVG. It allows a 38.2 % reduction in IOP from the baseline, reduces the number of IOP-lowering medications by 59.9 %, and preserves visual acuity in 77 % of cases.