The efficacy and safety of diode laser cycloablation in the treatment of refractory glaucoma in a South African population

Thomas, Jason Peter (2022-04)

Thesis (MMed)--Stellenbosch University, 2022.

Masters

ENGLISH SUMMARY: The development of a safe and effective protocol for trans-scleral cyclophotocoagulation in a Southern African population presenting with refractory glaucoma to a tertiary eye care centre. prospective, non-randomised, observational study of patients attending the Eye Clinic at Tygerberg Hospital, Cape Town, South Africa between March 2018 and January 2020. 119 eyes of 105 eligible patients were treated during the study period. The mean laser power was 1766 ± 187 milliwatt per burn for a mean of 15.6 ± 2.9 burns per eye. Mean total delivered energy per eye was 55.28 ± 12.61 Joule. 64% of the patients who followed up for the entire six-month period had an intraocular pressure reduction of ≥ 30% and 42.2% of those followed up had an IOP of ≤ 22 mmHg. The pain scores reported by patients decreased significantly between pre-operatively and three months (coefficient -1.752, p<0.001) and between pre-operatively and six months (coefficient -1.498, p=0.002). There was not a statistically significant effect on the change in topical medication from pre-operatively to three months (coefficient = -0.089, p=0.186), nor from pre-operatively to six months (coefficient = -0.003, p=0.946). Oral acetazolamide use decreased from 50.4% of patients at the date of their initial cyclophotocoagulation treatment to 9.3% at three months and further to 7.8% at six months. One eye had a scleral perforation at the time of initial treatment; no further complications arose. An individualized, “pop-titrated” cyclophotocoagulation protocol is safe and effective for use in a Southern African population. Retreatment should be considered at three months if intraocular pressure is not adequately controlled.

AFRIKAANS OPSOMMING: Die ontwikkeling van ‘n veilige en effektiewe protokol vir trans-sklerale siklofotokoagulasie in ‘n Suider-Afrikaanse bevolking wat presenteer met onbeheerde gloukoom by ‘n tersiêre oogsorgsentrum. ‘n Prospektiewe, nie-gerandomiseerde, observasionele studie van pasiënte by die Tygerberg Hospitaal oogkliniek, Kaapstad, Suid-Afrika tussen Maart 2018 en Januarie 2020. 119 oë van 105 pasiënte was behandel gedurende die studieperiode. Die gemiddelde laser-energie was 1766 ± 187 milliwatt per laseraanwending vir ‘n gemiddeld van 15.6 ± 2.9 aanwendings per oog. Die gemiddelde energie toegepas per oog was 55.28 ± 12.61 Joule. 64% van pasiënte wie opgevolg het vir die ses-maand periode het ‘n intraokulêre druk verlaging van ≥ 30% en 42.2% van diegene het ‘n drukverlaging tot ≤ 22 mmHg gehad. Die pyntellings gerapporteer deur pasiënte het noemenswaardig verminder van pre-operatief en drie maande (koëffisiënt -1.752, p<0.001) en tussen pre-operatief en ses maande (koëffisiënt -1.498, p=0.002). Daar was nie ‘n statisties beduidende verandering in die gebruik van topikale medikasies tussen pre-operatief en drie maande (koëffisiënt = -0.089, p=0.186) of ses maande nie (koëffisiënt = -0.003, p=0.946). Orale asetazolamied verbruik het verminder vanaf ‘n vlak van 50.4% van pasiënte by aanvanklike behandelingsdatum tot 9.3% op drie maande en verder tot 7.8% op ses maande. Een oog het ‘n sklerale perforasie ontwikkel na laserbehandeling maar geen verdere komplikasies is gedokumenteer nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/124765
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