Endoscopic laser cycloplasty in treatment of patients with angle-closure glaucoma and plateau iris
https://doi.org/10.25700/NJG.2018.03.05
Abstract
PURPOSE: To study efficacy and safety of endoscopic laser cycloplasty in treatment of patients with angle-closure glaucoma with plateau iris.
METHODS: The study included 15 patients (23 eyes) with angle-closure glaucoma with plateau iris, 13 women, 2 men. Mild glaucoma was diagnosed in 24.7% of cases; moderate — in 34.8 %; advanced — in 30.4 %. Mean age was 69.1±8.7 years. Intraocular pressure (IOP) level before surgery with medical therapy ranged from 17 to 30 mm Hg (mean of 22±3.4 mm Hg). Mean number of hypotensive instillations used by the patients — 3.1±1.8. During the postoperative period all patients underwent tonometry, tonography, anterior segment OCT and ultrasonic biomicroscopy (UBM). Follow-up period was 3 months.
RESULTS: All patients had an improvement of visual acuity during the postoperative period. In all cases we observed a decrease in IOP from 22±3.4 mm Hg (before surgery) to 19.3±2.2 mm Hg (in 3 months) and an increase of the aqueous humor outflow facility coefficient from 0.18±0.06 mm3/min⋅mm Hg (prior to the surgery) to 0.34±0.05 mm3/min⋅mm Hg (in 3 months). According to OCT data in 3 months, the anterior chamber angle remained open with a mean width of 32.6±3.5 degrees. UBM results showed an increase in morphometric values of the anterior chamber angle with a reduction in ciliary processes length from 512.1±118.6 µm before surgery to 403.3±112.4 in 3 months.
CONCLUSION: Endoscopic laser cycloplasty in all the cases allowed for IOP reduction without hypotensive therapy and glaucoma progression halt due to opening of the anterior chamber angle and eliminating risk of IOP increase.
About the Authors
A. A. Markova
Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution.
Russian Federation
Russian Federation
M.D., Ambulatory surgery and Conservative Treatment Department.
10 pr. Tractorostroiteley, Cheboksary, Russian Federation, 428028.
N. Y. Gorbunova
Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution; Postgraduate Medical Institute.
Russian Federation
Russian Federation
Ph.D., Head of the Glaucoma Department.
10 pr. Tractorostroiteley, Cheboksary, Russian Federation, 428028.
3 Red Square, Cheboksary, Russian Federation, 428032.
N. A. Pozdeyeva
Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution; Postgraduate Medical Institute.
Russian Federation
Med.Sc.D., Deputy Director for Science.
Russian Federation
Med.Sc.D., Deputy Director for Science.
10 pr. Tractorostroiteley, Cheboksary, Russian Federation, 428028.
3 Red Square, Cheboksary, Russian Federation, 428032.
References
1. Alekseev V.N., Martynova E.B. New a pproaches to hypotensive therapy of primary open-angle glaucoma. Cons. Medicum. 2001; 3:3-9. (In Russ.).
2. Federal research institute «Health organization and informatics» of Ministry of Health of the Russian Federation. Morbidity of population of Russia in 2009. Statistical data. Part II. Moscow, 2010. (In Russ.).
3. Quigley H.A., Broman A.T. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90(3):262-267. doi: 10.1136/bjo.2005.081224
4. Avetisov S.E. Oftal’mologiya. Natsional’noe rukovodstvo. [Ophthalmology. National guidelines]. Edited by: S.E. Avetisov, E.A. Egorov, L.K. Moshetova, V.V. Neroev, Kh.P. Takhchidi. Moscow: GEOTAR-Media Publ.; 2008: 944 p. (In Russ.).
5. Faizieva Yu.S. Angle-closure glaucoma: diagnosis, clinic and treatment. Rossiiskaya oftal’mologiya onlain. 2012; 5. (In Russ.). Available from: http://www.eyepress.ru/article.aspx?10291
6. Yoshiaki K., Mochizuki H., Kusanagi K. Plateau Iris. Glaucoma. Basic and Clinical Concepts. 2011; 523-534. doi: org/10.5772/18917.
7. Llinas A., Dorairaj S., Liebmann J., Ritch R. Plateau iris syndrome in a child. Eye. 2008; 22:597-602. doi: org/10.1038/sj.eye.6703088.
8. Pavlin C.J., Foster F.S. Plateau iris syndrome: changes in angle opening associated with dark, light, and pilocarpine administration. Am J Ophthalmol. 1999; 128(3):288-291. doi: org/10.1016/s0002-9394 (99)00149-x.
9. Yasuda N., Kageyama M. The long-term effects of local medication on intraocular pressure control in primary angle-closure glaucoma. Nippon Ganka Gakkai Zasshi. 1998; 92(10):1644-1649.
10. Kumar R.S., Baskaran M., Chew P.T., Friedman D.S. et al. Prevalence of plateau iris in primary angle closure suspects an ultrasound biomicroscopy study. Ophthalmology. 2008; 115(3):430-434.
11. Filho D.A., Cronemberger S., Merula R.V., Calixto N. Plateau Iris. Arq Bras Oftalmol. 2008; 71(5):752-758. doi: org/10.1590/s0004-27492008000500029.
12. Polikoff L.A., Chanis R.A., Toor A., Ramos-Esteban J.C. et al. The effect of laser iridotomy on the anterior segment anatomy of patients with plateau iris configuration. J Glaucoma. 2005; 14(2):109-113. doi: org/10.1097/01.ijg.0000151687.96785.03.
13. Choi J.S., Kim Y.Y. Progression of peripheral anterior synechiae after laser iridotomy. Am J Ophthalmol. 2005; 140(6):1125-1127. doi: org/10.1016/j.ajo.2005.06.018.
14. Nonaka A., Kondo T., Kikuchi M., Yamashiro K. et al. Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure. Ophthalmology. 2006; 113(3):437-441. doi: org/10.1016/j.ophtha.2005.11.018.
15. Hayashi K., Hayashi H., Nakao F., Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology. 2000; 107(4):698-703. doi: org/10.1016/s0161-6420(00)00007-5.
16. Tran H.V., Liebmann J.M., Ritch R. Iridociliary apposition in plateau iris syndrome persists after cataract extraction. Am J Ophthalmol. 2003; 135(1):40-43. doi: org/10.1016/s0002-9394(02)01842-1.
17. Aznabaev M.T., Aznabaev B.M., Kriger G.S., Kidraleeva S.G. Endoscopic laser photocoagulation of the ciliary processes in patients with severe uncompensated forms of glaucoma. Vestn oftal’mol 1999; 6:6-7. (In Russ.).
18. Berke S.J. Endolaser cyclophotocoagulation in glaucoma management. Techniques in Ophthalmol. 2006; 4(2):74-81. doi: org/10.1097/00145756-200606000-00008.
19. Carter B.C., Plager D.A., Neely D.E., Sprunger D.T. et al. Endoscopic diode laser cyclophotocoagulation in the management of aphakic and pseudophakic glaucoma in children. J AAPOS. 2007; 11(1):34-40. doi: org/10.1016/j.jaapos.2006.08.015.
20. Clement C.I., Kampougeris G., Ahmed F., Cordeiro M.F. et al. Com bining phacoemulsification with endoscopic cyclophotocoagulation to manage cataract and glaucoma. Clin Experiment Ophthalmol. 2013; 41(6):546-551. doi: org/10.1111/ceo.12051.
21. Francis B.A., Kawji A.S., Vo N.T., Dustin L. et al. Endoscopic cyclo photocoagulation in the management of uncontrolled glaucoma with prior aqueous tube shunt. J Glaucoma. 2011; 20(8):523-527. doi: org/10.1097/ijg.0b013e3181f46337.
22. Gowri J.M., Praveen R.M., Krishna R.M., Vinay V.K. et al. A study of endoscopic cyclophotocoagulation for the treatment of refractory glaucomas. Indian J Ophthalmol. 2009; 57(2):127-132. doi: org/10.4103/0301-4738.45502.
23. Huang T., Wang Y.J., Chen J.Q., Yu M.B. et al. Effect of endocyclopho tocoagulation on survival of corneal grafts. Zhonghua Yan Ke Za Zhi. 2007; 43(4):313-318.
24. Chen J., Cohn R.A., Lin S.C., Cortes A.E. et al. Endoscopic photoco agulation of the ciliary body for treatment of refractory glaucomas. Am J Ophthalmol. 1997; 124(6):787-796. doi: org/10.1016/s0002-9394(14)71696-4.
25. Kahook M.Y., Noecker R.J. Endoscopic cyclophotocoagulation. Glaucoma today. 2006; 11:24-29.
26. Lee P.F. Argon laser photocoagulation of the ciliary processes in cases of aphakic glaucoma. Arch Ophthalmol. 1979; 97(11):2135-2138. doi: org/10.1001/archopht.1979.01020020453008.
27. Lima F.E., Carvalho D.M., Avila M.P. Phacoemulsification and endo scopic cyclophotocoagulation as primary surgical procedure in coex isting cataract and glaucoma. Arq Bras Oftalmol. 2010; 73(5):419-422.
28. Lindfield D., Ritchie R.W., Griffiths M.F. ‘Phaco-ECP’: combined endo scopic cyclophotocoagulation and cataract surgery to augment me dical control of glaucoma. BMJ Open. 2012; 2(3). doi: org/10.1136/bmjopen-2011-000578.
29. Pantcheva M.B., Kahook M.Y., Schuman J.S., Rubin M.W. et al. Com parison of acute structural and histopathological changes of the por cine ciliary processes after endoscopic cyclophotocoagulation and transscleral cyclophotocoagulation. Clin Exp Ophthalmol. 2007; 35(3):270-274. doi: org/10.1111/j.1442-9071.2006.01415.x.
30. Plager D.A., Neely D.E. Intermediate-term results of endoscopic diode laser cyclophotocoagulation for pediatric glaucoma. J AAPOS. 1999; 3(3):131-137. doi: org/10.1016/s1091-8531(99)70057-1.
31. Uram M. Ophthalmic laser microendoscope ciliary process ablation in the management of neovascular glaucoma. Ophthalmology. 1992; 99(12):1823-1828. doi: org/10.1016/s0161-6420(92)31718-x.
32. Yip L.W., Yong S.O., Earnest A., Ji J., Lim B.A. Endoscopic cyclopho tocoagulation for the treatment of glaucoma: an Asian experience. Clin Exp Ophthalmol. 2009; 37(7):692-697. doi: org/10.1111/j.1442-9071.2009.02120.x.
33. Richter G.M., Coleman A.L. Minimally invasive glaucoma surgery: current status and future prospects. Clin Ophthalmol. 2016; 10:189-206. doi: org/10.2147/opth.s80490.
34. Podbielsky D.W., Varma D.K., Tam D.Y., Ahmed I.I. Endocycloplasty. A new technique for managing angle-closure glaucoma secondary to plateau iris syndrome. Glaucoma Today. 2010; 10:29-31.
35. Larkin H. Endocycloplasty often effective for angle-closure glaucoma due to plateau iris. Eurotimes stories. 2016; 9.
36. Francis B.A., Pouw A., Jenkins D., Babic K., Vakili G., Tan J., Chopra V., Green R. Endoscopic cycloplasty (ECPL) and lens extraction in the treatment of severe plateau iris syndrome. J Glaucoma. 2016; 25(3): 128-133. doi: org/10.1097/ijg.0000000000000156.
37. Pashtaev N.P., Pozdeyeva N.A., Volkov A.V. A quantitative method of evaluating the condition blood-ocular barrier protein content and cells in the anterior chamber is a non-invasive way using KOWA FC: practical guide. Cheboksary; 2006: 6 p. (In Russ.).
Review
For citations:
Markova A.A., Gorbunova N.Y., Pozdeyeva N.A. Endoscopic laser cycloplasty in treatment of patients with angle-closure glaucoma and plateau iris. National Journal glaucoma. 2018;17(3):41-49. (In Russ.) https://doi.org/10.25700/NJG.2018.03.05
Views:
681
Email this article 