The study of the efficiency of micropulse transscleral cyclophotocoagulation in the combined treatment of patients with secondary neovascular glaucoma

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Abstract

Background: Neovascular glaucoma (NVG) is a highly refractory form, it is characterized by fast development and a high level of the intraocular pressure (IOP).

Aims: To evaluate the effectiveness of micropulse transscleral cyclophotocoagulation (mCPC) in the combined treatment of patients with secondary neovascular glaucoma.

Methods: The study included 32 patients (32 eyes) with secondary NVG as an outcome of diabetes mellitus and (or) thrombosis of the central retinal vein or its branches. The preoperative IOP averaged 38.8±8.8 mm Hg with the most intense hypotensive therapy. All the patients underwent mCPC. In the postoperative period, the patients were examined on the first day after the operation, then in 1 week, 1, 3, 6 months, 1 year after the operation.

Results: All the operations were performed without complications. Pain syndrome in all cases was stopped on the first day after surgery. Six patients had reactive hypertension on the first day, therefore, the hypotensive therapy was intensified. The IOP 1 week after mCPC was 20.9±7.9 mm Hg, after 1 month of observation — 23.7±6.0 mm Hg with the hypotensive therapy. 3–4 weeks post-surgery, six patients with the preserved visual function experienced a repeated IOP increase, and the Ahmed valve was implanted. 6 months after mCPC, the IOP level averaged 22.8±7.7 mm Hg with the hypotensive therapy. Against the background of the IOP compensation, anti-VEGF drugs were injected in 4 cases, followed by laser coagulation of the retina.

Conclusion: Application of mCPC in NVG glaucoma patients showed only a small number of postoperative complications. This method of laser treatment can be used in combination with panretinal laser coagulation before or after the surgery, including administration of anti-VEGF drugs before or after the surgery. In case of the IOP increase, mCPC may be repeated.

About the authors

Alla V. Sidorova

The S. Fyodorov Eye Microsurgery Federal State Institution

Email: sidorova@mntk.ru
ORCID iD: 0000-0001-9384-6117
SPIN-code: 2571-9398

M.D.

Russian Federation, Moscow

Anna V. Starostina

The S. Fyodorov Eye Microsurgery Federal State Institution

Email: anna.mntk@mail.ru
ORCID iD: 0000-0002-4496-0703
SPIN-code: 7106-2347

M.D., Ph.D.

Russian Federation, Moscow

Mariia A. Pecherskaia

The S. Fyodorov Eye Microsurgery Federal State Institution

Email: mari.praze@yandex.ru
ORCID iD: 0000-0002-3905-794X

MD, Graduate Student

Russian Federation, Moscow

Margarita R. Khabazova

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Author for correspondence.
Email: rita.khabazova@mail.ru
ORCID iD: 0000-0002-7770-575X

M.D.

Russian Federation, 20/1, Delegatskaya street, Moscow, 127473

Alexey A. Arisov

The S. Fyodorov Eye Microsurgery Federal State Institution

Email: docarisov@gmail.com
ORCID iD: 0000-0002-3172-3880

M.D.

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. A photograph of the anterior segment of the eye: severe iris rubeosis in a patient with terminal glaucoma.

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3. Fig. 2. Electronic gonioscopy: neovascularization of the structures of the anterior chamber angle.

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4. Fig. 3. A photograph of the anterior segment of the eye: а — before micropulse transscleral cyclophotocoagulation (arrows point to iris rubeosis); б — 7 days after micropulse transscleral cyclophotocoagulation (rubeosis iridis is less pronounced).

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5. Fig. 4. A photograph of the anterior segment of the eye: silicone valve drainage tube in the anterior chamber (iris rubeosis).

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6. Fig. 5. A photograph of the anterior segment of the eye: silicone valve drain tube in the posterior chamber.

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Copyright (c) 2021 Sidorova A.V., Starostina A.V., Pecherskaia M.A., Khabazova M.R., Arisov A.A.

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