Abstract. Neovascular glaucoma (NVG) is a secondary glaucoma characterized by the proliferation of fibrovascular tissue in the angle of the anterior chamber and increased intraocular pressure.

Purpose. To study the effectiveness of transscleral cyclophotocoagulation (TSCPC) in treating refractory NVG.

Materials and methods. Twenty-six patients (26 eyes) with NVG were under our observation and underwent TSCPC due to IOP non-compensation (more than 26 mm Hg) on maximal antihypertensive therapy were followed up. The mean patient age was 66.2 ± 12.1 years. These included 21 cases with NVG associated with PDR and 5 cases with NVG associated with CRVO or BRVO. Pain syndrome and corneal edema were noted in 12 patients, corneal erosion was reported in 6 patients out of these 12, and corneal ulceration was noted in 2 patients out of these 12. A diode laser (IRIDEX IQ) with a G-probe was used for TSCPC. We applied 14–22 laser applications within 270 degrees. The laser energy was from 1250 mW to 1500 mW, and the application duration was 4 s. Results. Before the treatment, the IOP in all patients was 34.54 ± 5.24 mm Hg, and after TSCPC IOP was 19.62 ± 7.38 mm Hg. After 24 months of follow-up, the IOP was 21.35 ± 5.90 mm Hg. The pain disappeared in 9 patients, corneal edema disappeared in 11 patients, and corneal erosions and ulcers epithelialized in all 8 patients. The number of IOP-lowering medications, used by all patients before treatment averaged 2.69 ± 1.12, and after treatment – 1.08 ± 0.84.

Conclusions. TSCPC is an effective method of treating refractory NVG. It allows a 38.2 % reduction in IOP from the baseline, reduces the number of IOP-lowering medications by 59.9 %, and preserves visual acuity in 77 % of cases.

Keywords: secondary neovascular glaucoma, transscleral cyclophotocoagulation, trabeculectomy, Ex-PRESS mini-shunt implantation, intravitreal anti-VEGF injection, intraocular pressure

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1. Wand M. Neovascular glaucoma. In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas - Clinical Science. 2nd. Ed. St. Louis: Mosby; 1996: 1073-1129. Ch 51.
2. Weiss DI, Shaffer RN, Nehrenberg TR. Neovascular glaucoma complicating carotid-cavernous fistula. Arch Ophthalmol. 1963; 69:304-307.doi.org/10.1001/archopht.1963.00960040310007
3. Yang Hongfang, Yu Xiaobo, Sun Xinghuai. Neovascular glaucoma: Handling in the future. Taiwan J Ophthalmol. 2018;8:53-5.doi.org/10.4103/tjo.tjo_39_18
4. Olmos LC, Lee RK. Medical and surgical treatment of neovascular glaucoma. Int Ophthalmol Clin. 2011 Summer; 51(3):27-36.doi.org/10.1097/IIO.0b013e31821e5960
5. Bai L, Wang Y, Liu X, Zheng Y, Wang W, He N, Tariq F, Wang F, Zhang S. The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma. Front Med (Lausanne). 2022 Jan 10;8:766032.doi.org/10.3389/fmed.2021.766032
6. Nabili S, Kirkness CM. Trans-scleral diode laser cyclophoto-coagulation in the treatment of diabetic neovascular glaucoma. Eye (Lond). 2004 Apr;18(4):352-6.doi.org/10.1038/sj.eye.6700644
7. Pastor SA, Singh K, Lee DA. Cyclophotocoagulation, a report by the American Academy of Ophthalmology. Ophthalmology 2001; 108: 2130-2138.doi.org/10.1016/S0161-6420(01)00889-2
8. Schlote T, Derse M, Zierhut M. Transscleral diode laser cyclophotocoagulation for the treatment of refractory glaucoma secondary to inflammatory eye diseases. Br J Ophthalmol. 2000 Sep;84(9):999-1003.doi.org/10.1136/bjo.84.9.999
9. Moussa K, Feinstein M, Pekmezci M, et al. Histologic changes following continuous wave and micropulse transscleral cyclophotocoagulation: A randomized comparative study. Transl Vis Sci Technol 2020; 9:22.doi.org/10.1167/tvst.9.5.22
10. Rotchford AP, Jayasawal R, Madhusudhan S, Ho S, King AJ, Vernon SA. Transscleral diode laser cycloablation in patients with good vision. Br J Ophthalmol. 2010 Sep;94(9):1180-3.doi.org/10.1136/bjo.2008.145565
11. Pantcheva MB, Kahook MY, Schuman JS, Rubin MW, Noecker RJ. Comparison of acute structural and histopathological changes of the porcine ciliary processes after endoscopic cyclophotocoagulation and transscleral cyclophotocoagulation. Clin Exp Ophthalmol. 2007 Apr;35(3):270-4.doi.org/10.1111/j.1442-9071.2006.01415.x
12. Choy BNK, Lai JSM, Yeung JCC, Chan JCH. Randomized comparative trial of diode laser transscleral cyclophotocoagulation versus Ahmed glaucoma valve for neovascular glaucoma in Chinese - a pilot study. Clin Ophthalmol. 2018 Dec 7;12:2545-2552.doi.org/10.2147/OPTH.S188999
13. Zemba M, Dumitrescu OM, Vaida F, Dimirache EA, Pistolea I, Stamate AC, Burcea M, Branisteanu DC, Balta F, Barac IR. Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma. Exp Ther Med. 2022 Apr;23(4):278.doi.org/10.3892/etm.2022.11207
14. Guzun O, Zadorozhnyy O, Nasinnyk I, Chargui W, Oueslati Y, Korol A. Efficacy of Nd:YAG and diode laser transscleral cyclophotocoagulation in the management of neovascular glaucoma associated with proliferative diabetic retinopathy. J.ophthalmol. (Ukraine) [Internet].2024 Jul. 2 [cited 2024 Aug. 15];(3):8-15.doi.org/10.31288/oftalmolzh20243815
15. Khodeiry MM, Lauter AJ, Sayed MS, Han Y, Lee RK. Primary slow-coagulation transscleral cyclophotocoagulation laser treatment for medically recalcitrant neovascular glaucoma. Br J Ophthalmol. 2023;107(5):671-676.doi.org/10.1136/bjophthalmol-2021-319757
16. Ramli N, Htoon HM, Ho CL, et al. Risk factors for hypotony after transscleral diode cyclophotocoagulation. J Glaucoma 2012; 21:169-173.doi.org/10.1097/IJG.0b013e318207091a
17. N. Liao, C. Li, H. Jiang, A. Fang, S. Zhou, and Q. Wang. Neovascular glaucoma: a retrospective review from a tertiary center in China, BMC Ophthalmology, vol. 16, p. 14, 2016.doi.org/10.1186/s12886-016-0190-8
18. H. Park, J. Kim, M. Ahn, et al. Level of vascular endothelial growth factor in tenon tissue and results of glaucoma surgery, Archives of Ophthalmology, vol. 130, pp. 685-689, 2012.doi.org/10.1001/archophthalmol.2011.2799
19. Sydorchuk UP, Novytskyy II. Efficacy of a combination of conservative and surgical methods of treatment for neovaascular glaucoma associated with diabetic retinopathy and central or branch retinal vein occlusion. J.ophthalmol. (Ukraine) [Internet]. 2024 Jul. 2 [cited 2024 Aug. 15];(3):16-2doi.org/10.31288/oftalmolzh202431623