Efficacy of Limited Cyclophotocoagulation in the Treatment of Refractory Glaucoma Among Adults Patients Treated at a Tertiary Hospital in Northern Tanzania
Vulfrida A. Kyara
*
Department of Ophthalmology, KCMC University, Moshi, Tanzania.
Kevin Rwegoshola
Kilimanjaro College of health and allied Sciences, Tanzania.
Andrew Makupa
Department of Ophthalmology, KCMC University, Moshi, Tanzania and Department of Ophthalmology, Kilimanjaro Christian medical Centre, Moshi, Tanzania.
William Makupa
Department of Ophthalmology, KCMC University, Moshi, Tanzania and Department of Ophthalmology, Kilimanjaro Christian medical Centre, Moshi, Tanzania.
*Author to whom correspondence should be addressed.
Abstract
Background: Refractory glaucoma possess a therapeutic challenge due to poor response to standard medical and surgical treatments. Cyclophotocoagulation (CPC) is an alternative method for lowering intraocular pressure (IOP) in such cases, however its use is often limited to advanced disease due to variable outcomes and complications after destructive procedure on the ciliary body.
Objective: To assess the efficacy of limited CPC in reducing IOP among adult patients with refractory glaucoma at Kilimanjaro Cristian Medical Center, Ophthalmology department between 2023 and 2024.
Methodology: A prospective study was conducted involving 74 patients who underwent transscleral CPC. Laser was applied to the inferior 180° of the ciliary body with 10 burns per quadrant at 2000 mW for 2 seconds per burn. Treatment success was defined as achieving an IOP ≤ 21 mmHg and ≥ a 20% reduction from baseline at three months with or without treatment.
Results: At three months, 36 patients (48.6%) achieved target IOP (≤ 21mmHg and ≥ 20% reduction), while 63 (85.1%) had at least 20% reduction in IOP. The median baseline IOP decreased from 46.5 mmHg (IQR 39-56) to 25mmHg (IQR 18-38). Lower pre-treatment IOP (AHR=0.95; 95% CI: 0.91-0.99; P= 0.015) and optic disc notching were positively associated with treatment success, while ocular comorbidities were negatively associated (AHR = 0.33; 95% CI: 0.14-0.74; P=0.007). The most common complications were transient uveitis (10.8%) and cystoid macular edema (8.1%).
Conclusion: Limited CPC showed moderate effectiveness in lowering IOP after a single session, with minimal complications. However, nearly half of the patients required a repeat procedure to achieve target IOP at three months.
Keywords: Refractory glaucoma, limited cyclophotocoagulation, transscleral CPC, intraocular pressure reduction, laser therapy complications