A Review of Cyclodestructive Procedures for the Treatment of Glaucoma

Figures & data

Figure 1. IRIDEX G-probe device

Table 1. Selection of Continuous Wave Transscleral Cyclophotocoagulation (CW-TSCPC) Studies from 2001–2019

Author, year	Tabibian et al. 2019	Ghosh et al. 2014	Frezzotti et al. 2010	Rotchford et al. 2010	Yildirim et al. 2009	Iliev & Gerber 2007	Vernon et al. 2006	Noureddin et al. 2006	Murphy et al. 2003	Pucci et al. 2003	Shah et al. 2001
Publication	J Glaucoma	Eur J Ophthalmol	Acta Ophthalmol	Br J Ophthalmol	J Glaucoma	Br J Ophthalmol	J Glaucoma	Eye	Br J Ophthalmol	Ophthalm-ologica	Ophthalm-ology
Study type	RP	RP	PP	RP	PP	RP	RP	PP	RP	RP	RP
Population	Refractory	POAG; with good vision	Refractory	Mixed; with good vision	NVG	Refractory/NVG	POAG	Refractory	Refractory	Refractory	Refractory
F/U (mths)	60	24	42	61	24	30	66	14	17	26	31
# of eyes	28	46	124	49	^aCW-TSCPC: 33 ^bAVG:33	131	59	36	263	120	28
Mean baseline IOP (mmHg)	30	24	30	28	^a43 ^b43	37	31	36	41	30	33
Mean reduction (mmHg)	18	7	12	13	^a25 ^b20	22	16	17	23	10	16
% IOP reduction	60	29	40	46	^a58 ^b47	59	52	47	56	33	48
Mean preop. Meds.	2.8	2.5	3.5	2.3	^a2.6 ^b3.3	2.97	2.6	2.8	1.7	4.5	2.6
Mean meds. reduction	1.1	0.3	0.2	0.4	^a0.8 ^b1.3	1.93	0.84	1.92	0.9	2.2	1
Laser settings	2.5 W, 2.0 s, 15 burns	2.5 W, 2.0 s, 12–14 burns	2.0 W, 2.0 s, 10–15 burns	2.0 W, 2.0 s, 14 burns	^a,b1.5 W, 2.0 s, 16–20 burns	1.75–2.0 W, 2.0 s	2.0 W, 2.0 s, 14 burns	2.25 W, 2 s, 26–28 burns	—	1.6–2.0 W, 2.0 s, 1–15 burns	1.5 W, 1.5 s, 40 burns
% VA decline	32	20	31	31%	^a24 ^b27	—	64	22	20	24	26
% Hyp./Phth.	0/0	0/0	0/0	0/0	^a12/0 ^b3/6	18/10	5/0	3/0	9/5	0/0	4/0
% CME	0	0	2	6%	^a0 ^b21	0.8	2	6	0.4	0	0

Data ranging from 2001–2019 on the efficacy and safety of CW-TSCPC in a wide range of populations. A Mixed population indicates there was no clear majority in the type of glaucoma studied. RP, retrospective; PP, prospective; F/U, follow-up; preop., preoperative; meds., glaucoma medications; VA, visual acuity; Hyp., hypotony; Phth., phthisis; CME, cystoid macular edema; POAG, primary open-angle glaucoma; NVG, neovascular glaucoma; ^acontinuous wave transscleral cyclophotocoagulation, ^bAhmed glaucoma valve.

Table 2. Selection of MicroPulse Transscleral Cyclophotocoagulation (MP-TSCPC) Studies from 2010–2020

Author, year	Anand et al. 2020	Nguyen et al. 2019	Varikuti et al. 2019	Zaarour et al. 2019	Garcia et al. 2019	Yelenskiy et al. 2018	Emanuel et al. 2017	Kuchar et al. 2016	Aquino et al. 2015	Tan et al. 2010	Ting et al. 2020
Publication	AGS meeting	Eur J Ophthalmol	J Glaucoma	J Glaucoma	Ophthalmol Glaucoma	J Glaucoma	J Glaucoma	Lasers Med Sci	Clin Exp Ophthalmol	Clin Exp Ophthalmol	J Glaucoma
Study type	RP	RP	RP	PP	RP	RP	RP	RP	PP	PP	RP
Population	Mixed	POAG	POAG	POAG	POAG	POAG	POAG	Mixed	Mixed	NVG	Mixed
F/U (mths)	12	12	12	15	12	25	12	2	18	18	12
# of eyes	51	95	61	75	116	197	84	19	^aMP-TSCPC: 24 ^bCW-TSCPC:24	40	32
Mean baseline IOP (mmHg)	25	25	26	26	22	22	28	38	^a37 ^b35	39	33.7
Mean reduction (mmHg)	9	8	10	11	7	6	17	15	^a17 ^b16	13	9.1
% IOP reduction	36	32	38	42	32	27	61	39	^a46 ^b46	33	27
Mean preop. meds.	3.8	3	3.5	3.53	3.2	3	3.3	2.6	^a2 ^b2	2.1	3.4
Mean meds. reduction	0.95	1.6	0.8	0.5	0.7	1	1	0.7	^a1 ^b1	0.8	0.6
Laser Settings	2.0–2.4 W, 360 s	2.0–2.5 W, 180 s	2.0 W, 159 s	2.0 W,90–120 s	2.0 W, 180 s	2.0 W, 90–120 s	1.6–2.4 W, 180–360 s	2.0 W, 100–240 s	^a,b2.0 W, 100 s	2.0 W, 100 s	1.5–2 W, 124–132 s
% VA decline	2	—	21	14	8	0	41	21	^a4 ^b9	0	0
% Hyp./Phth.	6/0	0/0	2/0	0/0	2/0	0/0	6/0	5/0	^a0/0 ^b20/4	0/0	0
% Infl.	4	0	0	0	1	0	46	0	^a4 ^b30	10	0
% CME	6	0	3	0	1	2	0	0	0	0	0

Data ranging from 2010–2020 on the efficacy and safety of MP-TSCPC in a wide range of populations. A Mixed population indicates there was no clear majority in the type of glaucoma studied. RP, retrospective; PP, prospective; F/U, follow-up; preop., preoperative; meds., glaucoma medications; VA, visual acuity; Hyp., hypotony; Phth., phthisis; Infl., prolonged inflammation; CME, cystoid macular edema; POAG, primary open-angle glaucoma; NVG, neovascular glaucoma; ^aMicroPulse transscleral cyclophotocoagulation, ^bcontinuous-wave tranasscleral cyclophotocoagulation.

Figure 2. (a) The Generation 1 MicroPulse Probe. (b) The Generation 2 MicroPulse Probe. (c) The Generation 1 MicroPulse Probe in use

Figure 3. (a) The endoscopic cyclophotocoagulation probe (ECP) (Endo Optiks, Little Silver, NJ) entering an eye. (b) Two intraoperative views of ciliary process during ECP treatment. Photographs from the archives of Dr. David Solá-Del Valle

Table 3. Selection of Endoscopic Cyclophotocoagulation (ECP) studies from 2007–2018

Author, year	Villavicencioet al. 2018	Bartolome et al. 2017	Ferguson et al. 2017	Murakami et al. 2017	Roberts et al. 2016	Marra et al. 2015	Francis et al. 2014	Clement et al. 2013	Francis et al. 2011	Kahook et al. 2007
Publication	J. Clin Exp. Ophth	Eur JOphthalmol	JCRS	J. Clin Exp. Ophth	Int’l Jrnl Ophth	Retina	JCRS	J. Clin Exp. Ophth	J. Glaucoma	J. Glaucoma
Study type	RP	RP	RP	RP	RP	RP	PP	RP	PP	RP
Population	POAG	POAG	OAG	Refractory	POAG	NVG	OAG	POAG	Refractory	POAG
F/U (mths)	24	12	12	24	12	12	36	12	18	6
# of eyes	41	^aPhaco/ECP: 69 ^bPhaco: 30	^cICE: 51 ^diStent/Phaco: 50	^eECP: 25 ^fGDD-2: 48	91	^gECP: 27 ^hControl: 27	^iPhaco/ECP: 80 ^jPhaco: 80	63	25	^k240°: 15 ^l360°: 25
Mean baseline IOP (mmHg)	22	^a22 ^b19	^c21 ^d21	^e24 ^f24	17	^g40 ^h35	^i18 ^j18	21	24	^k24 ^l25
Mean reduction (mmHg)	9	^a5 ^b2	^c7 ^d5	^e7 ^f9	3	^g28 ^h12	^i3 ^j1	5	9	^k8 ^l11
% IOP reduction	41%	^a23 ^b11	^c33% ^d24%	^e29% ^f38%	18%	^g70% ^h34%	^i17% ^j6%	24%	38%	^k32% ^l47%
Mean preop. meds.	2.08	^a2.6 ^b1.2	^c1.8 ^d1.7	^e3 ^f4	1.9	^g3.1 ^h1.3	^i1.5 ^j2.4	2.7	3.2	^k2.5 ^l2.6
Mean meds. reduction	0.48	^a0.7 ^b0.2	^c0.7 ^d1.1	^e1.5 ^f0.9	0.4	^g2.6 ^h-0.6	^i1.1 ^j0.1	1.4	1.7	^k0.6 ^l2.1
Laser settings (W)	0.2	^a,b0.25	^c,d0.2 mW	^e,f0.25–0.35	0.25	—	^i,j0.2–0.5	0.4	0.25–0.35	—
° processes treated	360	^a,b270–360	^c,d270	^e,f330-360	200–270	^g,h360	^i,j270-360	270-360	360	^k240 ^l360
% Hyp./Phth.	0	^a0/0 ^b0/0	—	—	—	^g7/7 ^h7/7	^i0/0 ^j0/0	0/0	0/0	^k0/0 ^l0/0
% CME	0	6 3	—	—	—	^g0 ^h0	^i0 ^j4	3	4	^k0 ^l0

Data ranging from 2007–2019 on the efficacy and safety of ECP in a wide range of populations. RP, retrospective; PP, prospective; F/U, follow-up; preop., preoperative; meds., glaucoma medications; Hyp., hypotony; Phth., phthisis; POAG, primary open-angle glaucoma; OAG, open-angle glaucoma; NVG, neovascular glaucoma; ^a,iPhacoemulsification and ECP, ^b,10phacoemulsification; ^ciStent, cataract extraction, and ECP, ^diStent and phacoemulsification; ^f2^nd glaucoma drainage device; ^hcurrent standard of care for NVG; ^k240° of ciliary processes treated, ^l360° of ciliary processes treated.

Table 4. Selection of High-Intensity Focused Ultrasound Cyclodestruction (HIFU) Studies from 2011–2017

Author, year	Giannaccare et al. 2017	Aptel et al. 2016	Aptel et al. 2015	Melamed et al. 2015	Denis et al. 2015	Aptel et al. 2014	Aptel et al. 2011
Publication	Graefes Arch Clin Exp Ophthalmol	EVER conference 2016	Acta Ophthalmol	Eur J Ophthalmol	Invest Ophthalmol Vis Sci	Curr Med Res Opin	Invest Ophthalmol Vis Sci
Study type	PP	PP	PP	PP	PP	PP	PP
Population	Refractory	POAG	OAG	Refractory	Refractory	Refractory (all POAG)	Refractory
F/U (mths)	6	6	12	12	12	12	6
# of eyes	30	520	30	20	^a4 s group: 24 ^b6 s group: 28	28	12
Mean baseline IOP (mmHg)	30	24	28	36	^a30 ^b29	29	38
Mean reduction (mmHg)	10	8	9	14	^a10 ^b11	7	13
% IOP reduction	33	33	32	39	^a33 ^b38	24	34
Mean preop. meds.	2.7	—	3.6	4.6	^a,bNo medication changes	3.8	—
Mean meds. reduction	0.7	—	0.5	0.6		0	—
Laser duration (s)	4, 6, or 8	8	6	6	^a4 ^b6	6	3–4
% CME	0	1.9	3.3	0	^a0 ^b4	—	0
% SPK	13	—	40	—	^a25 ^b39	—	25
% AC infl.	20%	0%	33	65	^a25 ^b25	—	0

Data ranging from 2011–2017 on the efficacy and safety of ECP in a wide range of populations. PP, prospective; F/U, follow-up; preop., preoperative; meds., glaucoma medications; Hyp., hypotony; Phth., phthisis; CME, cystoid macular edema; SPK, superficial punctate keratitis; AC infl., transient anterior chamber inflammation; POAG, primary open-angle glaucoma; OAG, open-angle glaucoma; ^agroup treated for 4 seconds, ^bgroup treated for 6 seconds.

Youn J, Cox TA, Herndon LW, Allingham RR, Shields MB. A clinical comparison of transscleral cyclophotocoagulation with neodymium: YAG and semiconductor diode lasers. Am J Ophthalmol. 1998;126(5):640–647. doi:10.1016/S0002-9394(98)00228-1.

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