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Transscleral cyclophotocoagulation with MicroPulse® laser versus Ahmed valve implantation in patients with advanced primary open-angle glaucoma

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Abstract

Purpose

To compare the efficacy of transscleral cyclophotocoagulation with MicroPulse® laser (Iridex, Silicon Valley, California, USA) with 3000 mW to Ahmed valve implantation in eyes with advanced stage of primary open-angle glaucoma.

Methods

In a prospective observational clinical study, 30 patients (30 eyes) with advanced open-angle glaucoma were randomized for either micropulse transscleral cyclophotocoagulation with 3000 mW or Ahmed valve implantation. Fifteen eyes were treated with transscleral cyclophotocoagulation with MicroPulse® laser with 3000 mW (group A) and 15 eyes with Ahmed valve implantation (group B). As inclusion criteria are included the diagnosis of advanced primary open-angle glaucoma, an intraocular pressure above 21 mmHg, cup-to-disk ratio 0.9–1.0, failure to meet the target IOP with either maximal tolerated local medical therapy (2–4 antiglaucoma agents) or systemic therapy (acetazolamide). The follow-up time of the study was 12 months. An absolute success was defined the achievement of IOP between 6 and 15 mmHg and at least 30% reduction of the IOP from baseline under reduced or the same number of antiglaucoma agents after the surgical procedure without following glaucoma surgeries and as qualified success the achievement of IOP between 6 and 18 mmHg and at least 20% reduction of the IOP from baseline regardless of the number of postoperative antiglaucoma agents. The efficacy was evaluated by estimating the absolute success rate and the qualified success rate using the Kaplan–Meier survival analysis.

Results

A reduction of the intraocular pressure > 30% was achieved in 33.3% of group A and in 73.3% of group B during the follow-up period of 12 months. A statistically significant decrease in the number of eye drops was observed in both groups (p < 0.01). 53.3% of the eyes of group A underwent additional anti-glaucoma procedures to achieve target intraocular pressure. The number of the local medications that were administered 12 months after the ocular surgery was 2 (± 1.3) in group A and 0.57 (± 0.9) in group B, compared to 3.2 (± 0.78) in group A and 3.33 (± 0.7) in group B administered prior to the surgery (p: 0.016). 8 eyes (53.33%) in group A were referred for additional treatment due to an acute postoperative rise in IOP (5 eyes: mTS-CPC, 1 eye: canaloplasty, 2 eyes: AGV implantation). No further anti-glaucoma procedures were necessary in group B.

Conclusion

The Ahmed valve implantation achieves a more efficient decrease of the intraocular pressure as well as of the number of antiglaucoma agents than the transscleral cyclophotocoagulation with MicroPulse® diode laser 3000 mW. Additionally, the Ahmed valve implantation showed better results in terms of absolute and qualified success rates in the treatment of advanced primary open-angle glaucoma.

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Data availability

All data generated or analyzed during this study are included in this published article

Abbreviations

AC:

Anterior chamber

AGV:

Ahmed valve implantation

BCVA:

Best corrected visual acuity

GAT:

Goldmann applanation tonometry

IOP:

Intraocular pressure

MIGS:

Micro-invasive glaucoma surgery

mTS-CPC:

MicroPulse® transscleral cyclophotocoagulation

PEX:

Pseudoexfoliation

POAG:

Primary open-angle glaucoma

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Acknowledgements

The authors received no outside financial support for this study, including pharmacological or industry support.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Clinic of Ophthalmology, St. Johannes Hospital in Dortmund, Johannesstraße 9-13, 44137, Dortmund, Germany

    Sofia Fili, Kalliopi Kontopoulou, Georgios Perdikakis, Styliani Alexia Papadonta, Eleni Zaira Armeni & Markus Kohlhaas

  2. Clinic of Ophthalmology Pallas, Zurich, Switzerland

    Iraklis Vastardis

Authors
  1. Sofia Fili
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  2. Kalliopi Kontopoulou
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  3. Iraklis Vastardis
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  4. Georgios Perdikakis
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  5. Styliani Alexia Papadonta
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  6. Eleni Zaira Armeni
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  7. Markus Kohlhaas
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SF, KK, IV, GP, SAP, EZA and MK. The first draft of the manuscript was written by SF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sofia Fili.

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Conflicts of interest

The authors declare that there is no conflict of interest. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this observatory study involving human participants were in accordance with the ethical standards of the institutional research committee of St-Johannes-Hospital in Dortmund, Germany and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent for participation was obtained from all individual participants included in the study.

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Informed consent for publication was obtained from all individual participants included in the study.

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This is an observatory study and no clinical trial registration is necessary.

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Fili, S., Kontopoulou, K., Vastardis, I. et al. Transscleral cyclophotocoagulation with MicroPulse® laser versus Ahmed valve implantation in patients with advanced primary open-angle glaucoma. Int Ophthalmol 41, 1271–1282 (2021). https://doi.org/10.1007/s10792-020-01682-0

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