/ /

  • linkedin
  • Increase Font
  • Sharebar

    Optimizing CPC treatment outcomes with built-in transillumination

    Probe enables physicians to locate ciliary body, deliver therapy in more targeted manner

     

    Transillumination technique

    When performing standard TSCPC, optimal placement for the probe has long been an issue for debate.15,16 Typically, probes are placed about 1.5 mm posterior to the limbus for noncontact treatment17,18 and 0.5 to 1 mm posterior to the limbus for contact cycloablation.19

    However, there is variability in the location of the ciliary body, not only in different eyes,20 but also in different quadrants of the same eye.21 Refractive error may also affect position of the ciliary body.21 Therefore, depending on where the probe is placed, it is possible that treatment is not being directed to the appropriate area. Clinicians are, essentially, blindly treating with the laser.

     

    To combat this variability, I have utilized a light in the past in order to illuminate the eye and improve visualization of the ciliary body. Results were much more accurate and effective when using illumination and I eventually spoke with the manufacturer about creating a probe that included an illumination component. Together, we worked to develop a targeted CPC probe with built-in transillumination (G-Probe Illuminate).

    The wedged-tip of the probe is designed to be positioned directly on the eye, allowing for precise placement while the light illuminates the anterior margin of the ciliary body. This is useful with patients who have conditions resulting in abnormal ocular size, when the limbus is difficult to visualize, in cases of high myopia, and post-corneal transplant patients, as the ciliary body may be more posterior.

    Treatment with this probe can be used on a variety of patients, whether they have open- angle or angle-closure glaucoma, in conjunction with cataract surgery, or as a stand-alone procedure.

    I typically use this optimized probe on patients with uncontrolled glaucoma who are taking two to four medications. I also prefer eyes that are “quieter,” without an inflammatory element, as any time there is inflammation there is a risk of causing further complications.

    This optimized probe allows for an efficient, straight-forward, single-handed procedure that enables treatment with less power and results in significantly improved outcomes, with patients experiencing 30% to 50% IOP reduction rates. Less power and more precise treatments also reduce complications related to unnecessary tissue destruction.

    This probe can also potentially be used in the office as opposed to the operating room, creating greater convenience and accessibility.

    TSCPC has undergone an evolution in safety and efficiency with the micropulse CPC treatment. Now, standard TSCPC treatment has evolved with the ability to illuminate the eye for more precise treatment, an invaluable enhancement clinicians are only just beginning to explore.

     

     

     

    Steven D. Vold, MD

    E: [email protected]

    Dr. Vold is founder of Vold Vision, Fayetteville/Bentonville, AR. He is a consultant for Iridex and receives royalties from G-Probe Illuminate.

     

    References

    1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262-267. doi:/10.1136/bjo.2005.081224.

    2. Okeke CO, Quigley HA, Jampel HD, et al. Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. Ophthalmology. 2009;116:191-199.

    3. Feldmann RM, El-Harazi SM, LoRusso FJ, McCash CE, Lloyd WC 3rd, Warner PA. Histopathologic findings following contact transscleral semiconductor diode laser cyclophotocoagulation in a human eye. J Glaucoma. 1997;2:139-140.

    4. Noecker RJ, Kelly T, Patterson E, Herrygers LA. Diode laser contact transscleral cyclophotocoagulation: getting the most from the G-probe. Ophthalmic Surg Lasers Imaging. 2004;35:124-130.

    5. Schlote T, Derse M, ZIerhut M. Trans-scleral diode laser cyclophotocoagulation for the treatment of refractory glaucoma secondary to inflammatory eye diseases. Br J Ophthalmol. 2000;84:999-1003.

    6. Schlote T, Derse M, Rassman K et al. Efficacy and safety of contact trans-scleral diode laser cyclophotocoagulation for advanced glaucoma.
    J Glaucoma. 2001;10:294-301.

    7. Egbert PR, Fladoyor S, Budenz DL et al. Diode laser trans-scleral cyclophotocoagulation as a primary surgical treatment for primary open-angle glaucoma. Arch Ophthalmol. 2001;119:345-350.

    8. Agarwal HC, Gupta V, Sihota R. Evaluation of contact versus non-contact diode laser cyclophotocoagulation for refractory glaucomas using similar energy settings. Clin Experiment Ophthalmol. 2004;32:33-38.

    9. Leszczynski R, Gierek-Lapinska A, Forminska-Kapuscik M. Trans-scleral cyclophotocoagulation in the treatment of secondary glaucoma. Med Sci Monit. 2004;10:CR542-548.

    10. Radcliffe N, Vold S, Kammer J, et al. MicroPulse trans-scleral cyclophotocoagulation (mTSCPC) for the treatment of glaucoma using the MicroPulse P3 device. Poster presented at the American Glaucoma Society annual Meeting. April 2015.

    11. Tan AM, Chockalingam M, Aquino MC, et al. Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma. Clin Experiment Ophthalmol. 2010;38:266-272.

    12. Aquino MC, Barton K, Tan AM, et al. Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Experiment Ophthalmol. 2014;10:1-7.

    13. Kuchar SD, Moster M, Waisbourd M. Treatment outcomes of microPulse transscleral cyclophotocoagulation in advanced glaucoma. Poster presented at: Congress of the American Glaucoma Society. 2015 Feb 27; San Diego.

    14. Johnstone M, Wang R, Padilla S, Wen K. Transcleral laser induces aqueous outflow pathway motion and reorganization. Poster presented at American Glaucoma Society annual meeting. March 4, 2017.

    15. Kosoko O, Gaarsterland DE, Pollack IP, Enger CL. The Diode Laser Ciliary Ablation Study Group. Long-term outcome of initial ciliary ablation with contact diode laser transscleral cycophotocoagulation for severe glaucoma. Ophthalmology. 1996;103:1294-1302.

    16. Schubert HD. Cyclophotocoagulation: how far posterior to the limbus is the ciliary body. Ophthalmology. 1989;96:139-140.

    17. Marsh P, Wilson DJ, Samples JR, Morrison JC. A clinicopathologic correlative study of noncontact ttransscleral Nd: YAG cyclophotocoagulation. Am J Ophthalmol. 1993;115:597-602.

    18. Hampton C, Shields MB. Transscleral neodymium-YAG cyclophotocoagulation. A histologic study of human autopsy eyes. Arch Ophthalmol. 1988;106:1121-1123.

    19. Allingham RR, de Kater AW, Bellows R, Hsu J. Probe placement and power levels in contact transcleral neodymium: YAG cyclophotocoagulation. Arch Ophthalmol. 1990;108:738-742.

    20. Frieling E, Dembinsky B. Morphometry of the ciliary body using ultrasound biomicroscopy. Ophthalmologe 1995;92:745-749.

    21. Agrawal P, Martin KR. Ciliary body position variability in glaucoma patients assessed by scleral transillumination. Eye. 2008;22:1499-1503.

    New Call-to-action

    0 Comments

    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Poll

    View Results