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Título

HYPHEMA AFTER COMBINED TREATMENT WITH DIODE TRANSSCLERAL CYCLOPHOTOCOAGULATION (TCP) AND TRANSSCLERAL SUBCYCLOPHOTOTHERAPY (TSCP): A CASE REPORT

Resumo

Purpose: To present a case about a complication after TCP and TSCP combined treatment in a refractory glaucoma patient.

Methods: An 80-year-old male patient with a diagnosis of refractory glaucoma who underwent a combined TSCP (360°, 2W and 31.3% duty cycle for 90 seconds) and TCP (180°, 2W for 2 seconds) with Vitra 810 Quantel Medical Equipment.

Results:
An 80-year-old male patient with medical history of schizophrenia treated with clozapine and risperidone, exudative maculopathy in both eyes (OU) treated with vascular endothelial growth factors, glaucoma treated with maximal medical therapy and trabeculectomy OU and epiretinal membrane in the left eye (OS). Visual acuity was 8/10 in the right eye (OD) and 2/10 OS. Intraocular pressure (IOP) was 19mmHg OD and 36 mmHg OS. A combined TCP and TSCP technique was performed in the left eye. The following day, slit lamp examination revealed in treated eye corneal folds, tyndall ++ and IOP dropped to 6 mmHg. Patient was prescribed moxifloxacin + dexamethasone every 6 hours and difluprednate every 8 hours. A week after the procedure, he presented inferior hyphema with an IOP of 9mmHg. It was decided to increase the frequency difluprednate and after two weeks slit lamp examination showed no corneal folds, reabsorption of the hyphema and IOP of 9 mmHg.

Conclusion:
Diode cyclophotocoagulation is considered to be effective in reducing IOP in refractory glaucoma patients. It has shown to be a safer technique with a lower complication rate compared to other cyclodestructive procedures such as cryotherapy. Most common complications are inflammation of the anterior chamber, hyphema, hypotonia and loss of corneal transparency. These tend to be infrequent and quickly resolved with medical treatment.

Referências Bibliográficas

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-Dhanireddy S, Yin HY, Dosakayala N, Kurochkin P, Gupta N, Cheng AMS, Fechtner R, Alpert S. Severe Inflammation and Hyphema After Micropulse Diode Transscleral Cyclophotocoagulation. J Glaucoma. 2020 Jun;29(6