Reverse meridional cyclodialysis ab interno in surgical management of different types of glaucoma: long-term results

PURPOSE: To evaluate long term results of reverse meridional cyclodialysis (RMC) in decreasing intraocular pressure (IOP) in patients with different types of glaucoma.

METHODS: The study included twenty-one patients (21 eyes) who underwent RMC for different types of glaucoma. A specially designed cyclodialysis spatula was inserted through a clear corneal incision and ciliary body was gently detached from sclera creating a cleft of 2.5 mm wide and 6-6.5 mm deep. In 13 cases the patient had previously been operated for glaucoma, 3 patients had neovascular glaucoma, 8 patients had combined pathology and in 6 (29%) cases RMC was performed as an organ saving operation. There were also 3 (14%) patients with pain syndrome. Post-operative follow-up was > 2 years. IOP change, use of hypotensive medication(s), need for second surgery and postoperative complications were considered primary outcome measures. Success rates were evaluated using World Glaucoma Association’s guidelines. Results were statistically verified.

RESULTS: Mean baseline IOP was 30.2±7.2 mm Hg (95% coincidence interval (CI) — 27.0-33.5). At 2 years mean IOP decreased by 27.1±17.7% and was 20±1.4 mm Hg (95% CI —
19.2-20.8; p=0.0008). A direct correlation between IOP decrease and patency of cyclodialysis cleft was established. Use of hypotensive medication(s) prior to the operation was 2.6±0.9 (95% CI — 2.1-2.9), afterwards was reduced to 0.8±0.7 (95% CI — 0.4-1.2; p=2E-05). Total success was achieved in 67% cases (absolute success — in 24% (5/21), qualified — in 43% (9/21) cases. Failure rate was 33% (7/21) and in all such cases the underlying reason was cyclodialysis cleft closure. Hyphema, observed in 19% (4/21) cases, was the most common complication in early postoperative period. Two out of 3 eyes with pain syndrome were cured after RMC. All organ-saving operations were successful.

CONCLUSION: 1) There is a statistically significant decrease in IOP after ab interno RMC with patent cyclodialysis cleft in long term period.

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