Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
Graefes Arch Clin Exp Ophthalmol. 2021 Aug;259(8):2351-2361. doi: 10.1007/s00417-021-05157-5. Epub 2021 Apr 2.
Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population.
Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP.
IOP reductions of -35, -39, -25, -25, -23, -34, and -36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12-0.38]), and the drop persisted during the following 12 months.
The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.
经巩膜可控性光凝（COCO）是一种经巩膜 810nm 二极管激光光凝术，它利用光学反馈环自动调整施加的激光能量。本研究调查了在白种人群中，假性剥脱（PEX）对 COCO 疗效的影响。
对 130 例连续眼进行了为期 2 年的回顾性数据分析。分析了基线特征、眼压（IOP）、降眼压药物的数量、视野、最佳矫正视力（BCVA）和二次手术干预（SSI）。主要终点是与基线相比，M24 时的眼压降低，次要终点是眼压变化、降眼压药物减少、手术成功率以及根据 PEX 和基线 IOP 分层的眼压降低 SSI。
从基线到 D1、W1、M1、M3、M6、M12 和 M24，IOP 分别可降低-35%、-39%、-25%、-25%、-23%、-34%和-36%（均 p < 0.001），而术后眼压下降的药物数量随时间呈显著下降趋势（p < 0.001）。需要额外全身降眼压药物的眼比例从 M24 的 31%降至 0%（p = 0.025）。无 PEX 且基线 IOP < 30mmHg 的眼发生降眼压 SSI 的风险最低（p < 0.03）。BCVA 在 M12 时下降（0.25 [95% CI：0.12-0.38]），并在接下来的 12 个月中持续下降。
本研究表明，COCO 可在降低眼压和降眼压药物负担的同时，在中期降低眼压。无 PEX 且基线 IOP < 30mmHg 的患者发生 SSI 的风险较低。该手术本身不能排除是术后 BCVA 下降的原因。建议进一步进行前瞻性研究。
