Combined Technique for the Application of Micropulse Cyclophotocoagulation in Patients with Uncontrolled Glaucoma: Cyclo Mix

Abstract

Purpose: To describe the outcomes of a combined technique (Cyclo Mix) in uncontrolled glaucoma cases.

Materials and methods: Retrospective study. The Supra 810 nm subliminal laser (Quantel Medical, Cournon d'Auvergne, France) was used. A combined technique was performed using the subliminal mode (Subcyclo) in one hemifield (power of 2,000 mW, a duty cycle of 35%, and 80-150 seconds), and the continuous wave mode (Thermo Cyclo) on the other hemifield (power of 1,000 mW, exposure time of 2 seconds per spot). The primary endpoint was the probability of surgical failure. Mean intraocular pressure (IOP) change, best-corrected visual acuity (BCVA), number of glaucoma eye drops, and complications at 6 months postoperatively were secondary outcomes.

Results: Twenty-three eyes from 13 patients were included. Mean age was 61.4 ± 16.7 (range: 18-78 years), and 69% were female, with a baseline IOP of 20.3 ± 5.9 (range: 13-38 mm Hg). The cumulative probability of failure was 18 and 22% on days 90 and 180, respectively. Mean IOP reduction was -25.6 ± 20.9% at 6 months. The number of glaucoma eye drops was reduced to 1.2 ± 1 (p = 0.0024) at 6 months. No statistically significant change in the mean BCVA compared with baseline at 6 months was found (p = 0.84), and no severe complications were reported.

Conclusion: Cyclo Mix seems to be a safe therapy that effectively reduces the IOP and glaucoma medications in eyes with uncontrolled open-angle glaucoma for up to 6 months.

How to cite this article: Waldo L-G, Julio H-Q, Jennifer C-V, et al . Combined Technique for the Application of Micropulse Cyclophotocoagulation in Patients with Uncontrolled Glaucoma: Cyclo Mix. J Curr Glaucoma Pract 2020;14(3):93-97.

Keywords: Cyclodestruction; Glaucoma; Intraocular pressure; Micropulse laser; Transscleral cyclophotocoagulation.

Fig. 1

Representative drawing demonstrating the Cyclo Mix technique. First, the probe is set on Micropulse mode (Sub Cyclo) and applied with a continuous movement on the superior hemifield for 8 seconds (Green arrows). After that, the probe is changed to continuous-wave mode (Thermo Cyclo) and applied with 10–20 shots over the inferior hemifield (red circles)

Fig. 2

Kaplan–Meier plot of the probability of survival based on the criteria of failure that was defined as any of the following: IOP out of target range (5–18 mm Hg) or <20% reduction from baseline for 2 consecutive follow-up visits, additional surgery for glaucoma, or loss of light perception

Fig. 3

Line graph depicting the trend in intraocular pressure (IOP; median ± IQR) in mm Hg at baseline and through the follow-up time. *Difference between last from baseline IOP measurement with Wilcoxon rank test (p < 0.0001)

Fig. 4

Scatter plot of preoperative and postoperative intraocular pressure (IOP) after 6 months. Eyes are illustrated as circles. The oblique red line indicates no change of IOP. Circles above the oblique line represent a higher postoperative IOP. Eyes below the line of 18 mm Hg or 20% IOP reduction fulfilled the criteria of qualified success

Fig. 5

Number of medications (median ± IQR) at baseline through the last follow-up. *Difference between last from baseline glaucoma medications with paired Student's T-test (p < 0.0001)

Fig. 6

Distribution of change in best-corrected visual acuity from baseline to 6 months (n = 23)