Low-dose Transscleral Cyclophotocoagulation with phacoemulsi
A Study was conducted to explore the outcomes and mechanisms of intraocular pressure (IOP) control using low-dose transscleral cyclophotocoagulation (LDTSCP) followed by phacoemulsification in patients with prolonged acute primary angle closure (APAC).

Patients with prolonged APAC refractory to all other treatment modalities were prospectively recruited, and underwent LDTSCP (10 shots, 2s duration, 120° treatment with the energy starting at 1500mW and titrated to the level with audible burst but not exceeding 2000mW) and anterior chamber paracentesis 1 week prior to phacoemulsification with intraocular lens implantation and viscogoniosynechiolysis. Postoperative IOP, vision, anatomic changes on anterior segment optical coherence tomography and complications were recorded.

--20 eyes with prolonged APAC were recruited. Median follow-up was 12 months, at which point the vision in all eyes had improved and IOP was less than 17mm Hg on no antiglaucoma medications.

--Following LDTSCP at postoperative day (POD) 1, IOP decreased in all eyes to a median 15mm Hg.

--Post-LDTSCP supraciliary effusion (SCE) occurred in 90% of eyes on POD1 or POD7 and ciliary body defect (CBD) was detected in 30% of eyes and resolved in all cases by postoperative month 1.

--Lower post-LDTSCP IOP was associated with more number of bursts and higher grade of SCE, but not with total energy. Eyes with CBD and a higher number of bursts had higher grade SCE.

Finally, the post-LDTSCP IOP drop found in eyes with prolonged APAC might be explained by LDTSCP-induced SCE. LDTSCP was adequate to offer a relatively safe and successful bridge therapy prior to phacoemulsification, rather than the more traditional more comprehensive treatment.

Source: https://bjo.bmj.com/content/early/2021/08/29/bjophthalmol-2021-318880?rss=1