Opty

PurposeThis study aimed to describe the results of slow-cooking transscleral cyclophotocoagulation (SC-TSCP) with diode laser in patients with refractory glaucoma.MethodsThis retrospective study included 289 eyes of 263 patients who underwent the SC-TSCP technique at the glaucoma service of Oculare Ophthalmology Hospital, Brazil, with a minimum of one year of postoperative follow-up. We analyzed intraocular pressure, number of medications, postoperative complications, visual acuity, need for additional glaucoma surgery, need for repeat sessions of SC-TSCP, and the variables influencing success rates. ​​We used three criteria to analyze the technique's success: 1) Final IOP ≤ 21 mmHg, 2) Final IOP between 6 and 21 mmHg, and 3) Reduction of at least 30% in IOP.ResultsMean IOP dropped from 37.52 (±12.12) mmHg preoperatively to 14.48 (± 7.56) mmHg at the end of the study (p = 0.0001). The average reduction in IOP was 23.04 (±14.00) mmHg, representing a reduction of 61.41% in IOP (p = 0.0001). The mean number of medications dropped from 2.98 (±1.43) to 1.79 (±1.50) (p = 0.0001). Complete success (without eyedrops) was achieved in 25.61%, 18.69%, and 29.41% for each success criterion, and qualified success (with or without eyedrops) was achieved in 79.58%, 68.86%, and 85.43%, respectively. Visual acuity decreased from 1.99 LogMar (Snellen 20/1954) to 2.11 LogMar (Snellen 20/2576) (p = 0.0001). Seventy-two eyes (24.91%) needed a second session, 15 eyes (5.19%) needed a third cyclophotocoagulation, and one eye (0.35%) needed a fourth session. The most common complications were persistent hypotony (8.65%), corneal decompensation (6.23%), loss of light perception (5.88%), and phthisis (2.77%). After cyclophotocoagulation, 86.85% of the eyes did not require additional surgical procedures for IOP control.ConclusionThe slow-cooking transscleral cyclophotocoagulation technique proved highly effective in the prolonged control of intraocular pressure in severe and refractory glaucoma and demonstrated a favourable safety profile. However, in complex and refractory cases, severe complications such as vision loss or phthisis, although rare, may occur.

Purpose To investigate structural and functional correlations in glaucoma patients using optic nerve head hemoglobin (ONH Hb) measurements as determined by automated colorimetric analysis of conventional retinography. Methods We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (standard automated perimetry, SAP), color fundus imaging (mydriatic retinography), and peripapillary retinal nerve fiber layer (pRNFL) assessment through spectral-domain optical coherence tomography (SD-OCT). Software Laguna ONhE was used to estimate the amount of ONH Hb and to determine the glaucoma discriminant function (GDF) index. Scatter plots were constructed, and regression analysis was used to investigate the correlations between GDF, average pRNFL thickness, and VF mean deviation (VFMD) index values. A secondary analysis was performed to compare each parameter between three different glaucoma groups divided according to VFMD values (mild, >−6 dB; moderate, −6 to −12 dB; and advanced, <−12 dB). Results One hundred ninety-six eyes from 123 participants (69 with glaucoma and 54 controls) were enrolled. Overall, all parameters evaluated differed significantly between glaucomatous and control eyes (p ≤ 0.001). The comparison of each parameter according to groups of disease stages revealed significant differences between controls and each of the glaucomatous groups (p < 0.001). More pronounced changes in GDF values were observed in early disease stages. We found significant nonlinear correlations between GDF and VFMD values (R2 = 0.295, p < 0.001) and between pRNFL thickness and VFMD (R2 = 0.598, p < 0.001). A linear correlation was found between GDF and pRNFL thickness values (R2 = 0.195, p < 0.001). Conclusion Our results showed significant associations between ONH Hb values and both structural and functional damage in glaucoma obtained by SD-OCT and SAP, respectively. The nonlinear correlation we found and the GDF behavior along different disease stages suggest that ONH Hb levels' reduction may precede visual function changes in early glaucoma stages.