title: Intermediate term safety and efficacy of transscleral cyclophotocoagulation after tube shunt failure.
abstract: OBJECTIVE
  To determine the efficacy and safety of diode transscleral cyclophotocoagulation (TSCPC) after tube shunt failure.
  
  
  METHODS
  The patient population consisted of 32 eyes of 31 patients with uncontrolled glaucoma. Each eye had a previously implanted aqueous tube shunt and was currently on maximally tolerated medication. Each eye also underwent TSCPC treatment using the Iridex (Mountain View, CA) diode laser with a maximum of 360 degrees of treatment. All 31 charts were reviewed for data pertaining to demographics, treatment, ocular history, and follow-up clinical examinations. Safety was evaluated by complication data. Efficacy was evaluated in terms of TSCPC treatment parameters (number of laser applications, laser power, application duration, and degrees of ciliary body treated), intraocular pressure, number of hypotensive medications, and any further treatment required.
  
  
  RESULTS
  With a mean (SD) follow-up of 17.1 (16.3) (median=11.7) months from the last treatment, the mean intraocular pressure decreased from 28.6 (10.2) mm Hg to 16.8 (7.5) mm Hg (35% reduction) at 3 months (n=30, P<0.0001) and to 14.7 (7.9) mm Hg (43% reduction) at 1 year (n=13, P<0.0001). Complications included hypotony (n=4), hyphema (n=2), failed corneal transplant (n=1), and loss of light perception (n=5).
  
  
  CONCLUSIONS
  TSCPC has a significant ocular hypotensive effect on glaucoma refractory to both tube shunt and medical therapy. The safety of this intervention remains unclear in this high risk patient population and warrants further study.
authors.affiliation: Robert Cizik Eye Clinic, Houston, TX 77030, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Ness
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Khaimi
authors.forename: Robert M
authors.initials: RM
authors.lastname: Feldman
authors.forename: Rania
authors.initials: R
authors.lastname: Tabet
authors.forename: Steven R
authors.initials: SR
authors.lastname: Sarkisian
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Skuta
authors.forename: Alice Z
authors.initials: AZ
authors.lastname: Chuang
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Mankiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001082:Aqueous Humor / Q000378:metabolism; D002924:Ciliary Body / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D054023:Lasers, Semiconductor / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012590:Sclera; D014065:Tonometry, Ocular; D017211:Treatment Failure; D016896:Treatment Outcome