63
EW GLAUCOMA
October 2018
Contact information
Ezzouhairi: ezzouhairis@hotmail.com
be repeated if it fails, and is inexpen-
sive. "The limitation of cyclodestruc-
tion is the location on the ciliary
body. In order to focus the energy
accurately on the ciliary body, we
have to use systematic transillumi-
nation. This must be maintained
during the whole procedure and the
tip placement carefully controlled
at each impact. This allows better
targeting of the ciliary body, higher
efficacy, and less side effects and
complications," he explained.
In his own experience with
transillumination in 168 eyes with
refractory glaucoma, Dr. Ezzouhairi
applied the transscleral cyclodiode
along the entire circumference of
the ciliary body avoiding 3 and 9
o'clock as usual in one row in one
group and along three parallel rows
perpendicular to the circumference
in a second group of eyes. The en-
ergies used were in a soft mode and
without "pop" (1.2 watts maximum
for 2 seconds). He found that the
second group achieved a better IOP
reduction of 57% while the first
group achieved 40% IOP reduction.
Visual acuity, however, was not
significantly different in the two
groups. His main complication using
cyclodestruction was hypotony of
less than 5 mm Hg in both groups,
but significantly lower in eyes treat-
ed in a three rows mode than those
treated in a one row mode.
"Hypotony is the main risk
factor for cyclodiode therapy. The
rate of hypotony is influenced more
by higher energy applied at each
application than the total energy
delivered or the number of applica-
tions used. Furthermore, there is a
higher risk for hypotony and worse
overall outcomes in patients who
undergo multiple sessions. It occurs
mainly in complicated or complex
refractory glaucoma," Dr. Ezzouhairi
said. EW
References
1. Nassiri N, et al. Ahmed glaucoma valve and
single-plate Molteno implants in treatment of
refractory glaucoma: a comparative study. Am
J Ophthalmol. 2010;149:893–902.
2. Sarwat S, et al. Glaucoma drainage devices.
American Academy of Ophthalmology. EyeWi-
ki. Last updated May 2015.
3. Koh V, et al. Review of the Ahmed versus
Baerveldt study–5-year treatment outcomes.
Ann Eye Sci. 2017;2:18.
Editors' note: Dr. Ezzouhairi has
no financial interests related to
his comments.
