Incidence of hypotony and sympathetic ophthalmia following trans scleral cyclophotocoagulation for glaucoma and a report of risk factors

Aujla, Jaskirat S., Lee, Graham A., Vincent, Stephen J., & Thomas, Ravi (2013) Incidence of hypotony and sympathetic ophthalmia following trans scleral cyclophotocoagulation for glaucoma and a report of risk factors. Clinical and Experimental Ophthalmology, 41(8), pp. 761-772.

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Abstract

Background: To report the incidence and risk factors for hypotony and estimate the risk of sympathetic ophthalmia following diode laser trans-scleral cyclophotocoagulation (TSCPC).

Design: Retrospective study using data from a private tertiary glaucoma clinic and review of the literature.

Participants: Seventy eyes of 70 patients with refractory glaucoma who received TSCPC treatment.

Methods: Review of the records of consecutive patients who underwent TSCPC by a single ophthalmic surgeon and review of the literature.

Main Outcome Measures: Hypotony (including phthisis bulbi), sympathetic ophthalmia.

Results: Seven eyes (10%; CI 5-19%) developed hypotony and included 4 eyes that developed phthisis. Higher total energy delivered during TSCPC treatment was associated with an increased risk of hypotony: eyes that developed hypotony received a mean total energy of 192.5 ± 73.2 joules, compared to a mean of 152.9 ± 83.2 joules in hypotony-free cases. The difference in mean energy delivered between the hypotony and non-hypotony group was 38.53 (95% CI: -27.57 to 104.63). The risk of sympathetic ophthalmia estimated from a review of the published literature and current series was one in 1512, or 0.07% (CI 0.03% - 0.17%).

Conclusions: Total laser energy is one of several risk factors that act in a sufficient component cause-model to produce hypotony in an individual patient. The small sample size precluded inference for other individual putative risk factors but titrating laser energy may help decrease the occurrence of hypotony. The risk of sympathetic ophthalmia calculated from the literature is likely an overestimate caused by publication bias.

Impact and interest:

6 citations in Scopus
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3 citations in Web of Science®

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ID Code: 63705
Item Type: Journal Article
Refereed: Yes
Additional Information: Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)
Keywords: cyclophotocoagulation, diode laser, glaucoma, hypotony, total energy, multifactorial, sympathetic ophthalmia
DOI: 10.1111/ceo.12088
ISSN: 1442-6404
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300) > Ophthalmology (111301)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300) > Vision Science (111303)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Optometry & Vision Science
Copyright Owner: © 2013 The Authors
Clinical and Experimental Ophthalmology © 2013 Royal Australian and New Zealand College of Ophthalmologists
Copyright Statement: The definitive version is available at www3.interscience.wiley.com
Deposited On: 24 Oct 2013 23:15
Last Modified: 05 Dec 2014 21:47

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