Is cyclophotocoagulation an option in the management of glaucoma secondary to Fuchs' uveitis syndrome?

Glaucoma is one of the sight-threatening complications of Fuchs' uveitis syndrome (FUS) and the most difficult to manage. The goal of this study was to assess the efficacy and safety of cyclophotocoagulation (CPC) in the management of glaucoma secondary to FUS. In a retrospective analysis, the charts of all patients with FUS referred to our clinic from January 2002 to December 2012 were reviewed. In patients with glaucoma or ocular hypertension, controlled eye pressure was defined using two alternative upper limits of 6 a parts per thousand currency signaEuro parts per thousand IOP a parts per thousand currency signaEuro parts per thousand 21 mmHg and 6 a parts per thousand currency signaEuro parts per thousand IOP a parts per thousand currency signaEuro parts per thousand 18 mmHg at 1 year follow-up. One hundred and seventy-six patients with FUS were included in this study. Of those, 28 had ocular hypertension (OHT) or glaucoma. Mean maximal intraocular pressure (IOP) of patients with glaucoma/OHT was 40.8 mmHg. Twenty-three patients (82.1 %) had maximal IOP levels of 35 mmHg or higher. Sixteen patients with glaucoma/OHT underwent CPC alone (ten patients) or in combination with other surgical procedures (six patients). After 1 year, control of IOP for both upper limits (6 a parts per thousand currency signaEuro parts per thousand IOP a parts per thousand currency signaEuro parts per thousand 18 mmHg) and (6 a parts per thousand currency signaEuro parts per thousand IOP a parts per thousand currency signaEuro parts per thousand 21 mmHg) was achieved in six of ten patients (60 %) who received CPC alone, and in five of six patients (83.3 %) who required additional surgery after CPC. The mean number of cycloablative procedures was 1.3 (range 1-2) in the CPC alone group and 1.2 (range 1-2) in patients for whom CPC was used as adjunct therapy. There was no exacerbation of intraocular inflammation, no postoperative hypotony and no phthisis bulbi in the 16 patients who underwent CPC. CPC is a safe and effective procedure that should be considered if medical treatment has failed to control glaucoma in FUS.