Clinical predictors of surgical success after transscleral laser cyclothermotherapy in eyes with primary open-angle glaucoma

Abstract

Purpose. To evaluate the prognostic significance of early postoperative anterior chamber flare and ciliary body thickness changes for predicting the hypotensive efficacy of transscleral laser cyclothermotherapy (TLCTT) in patients with primary open-angle glaucoma (POAG). Methods. This retrospective study included 33 patients (33 eyes) with medically uncontrolled POAG treated with TLCTT using a standardized energy protocol (0.5 W, 20 s, up to 16 applications). The primary outcome was surgical success, defined as a ≥20% reduction in intraocular pressure (IOP) beginning one month after surgery. IOP and topical hypotensive therapy were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. On the first postoperative day, visible anterior chamber flare was recorded by slit-lamp biomicroscopy, and ciliary body thickness was measured using anterior segment optical coherence tomography (CASIA2, Tomey, Japan). Results. TLCTT produced a significant and sustained reduction in IOP throughout the 12-month follow-up period. Mean IOP decreased from 32.6 mmHg preoperatively to 23.7 mmHg at the final examination, corresponding to a mean reduction of 23.8% (p<0.001). Surgical success was achieved in 24 of 33 eyes (72.7%). Visible anterior chamber flare was observed in 72.7% of patients and demonstrated a strong positive correlation with postoperative IOP reduction (r=0.72, p<0.05). All eyes with visible flare achieved the predefined success criterion, whereas only 30% of eyes without flare reached successful pressure control. Ciliary body thickness increased significantly on the first postoperative day (0.69±0.09 mm vs. 0.86±0.08 mm; p<0.0001). The magnitude of postoperative ciliary body thickening was strongly correlated with subsequent IOP reduction (r=0.86, p<0.05). Conclusions. Early postoperative inflammatory response, manifested by visible anterior chamber flare and increased ciliary body thickness, is strongly associated with the longterm hypotensive efficacy of TLCTT. These parameters may serve as practical early predictors of treatment success and facilitate postoperative prognosis in patients with POAG undergoing cyclodestructive laser surgery.