ThermoCyclo for last resort treatment

What is ThermoCyclo ?

A LAST RESORT TREATMENT

TREATMENT GUIDELINES

TREATMENT GUIDELINES

What is ThermoCyclo?

Also referred to as Transscleral Cyclophotocoagulation (TSCPC), Thermocyclo is a destructive laser technique for treatment of advanced uncontrollable or refractory glaucoma.

The ciliary processes and ciliary body are targeted with a continuous wave of 810 nanometer laser energy for a duration long enough to thermally denature tissue, resulting in the reduction of aqueous humor production, resulting in a decrease of Intra Ocular Pressure (IOP).

An audible sound of the ciliary process bursting may sometimes be heard during this procedure.

Technology

The treatment is performed with the Vitra 810 laser from Quantel Medical using Thermocyclo treatment settings and the SubCyclo® laser probe with footplate attached.

The footplate ensures the correct probe angle for laser delivery, parallel to the visual axis and perpendicular to the iris plane.

Treatment guidelines

Always use the appropriately rated safety eyewear when operating a laser.

Glaucoma treatment: Thermocyclo procedure

Thermocyclo is indicated in the following:
Aphakic Glaucoma Neovascular Glaucoma Uveitis Glaucoma Refractory Pediatric Glaucoma Glaucoma after intravitreal silicone oil
Where patients may have experienced
Previous failed filtration surgery with poor prognosis for retreatment post-penetrating keratoplasty or scleral buckling Combined with poor visual potential And/Or Require pain relief Are unsuitable for filtration surgery Have not responded effectively to pharmacological treatment Have not responded effectively to other laser therapies such as SubCyclo photocoagulation, peripheral iridotomy and/or SLT

ThermoCyclo is contraindicated
For albino patients Eyes with a total occlusion of aqueous outflow
Anaesthetic
Local anaesthetic is necessary; retrobulbar or peribulbar injection, or sub tenon anaesthesia with 2% mepivacaine or equivalent.
Warning
Excess treatment power may result in ocular surface burns or ciliary body hemorrhage. The maximum possible laser power for this device is 2500 mW.

Patient Preparation

A lid speculum may be used to maintain appropriate access to the palpebral fissure. Apply methylcellulose to the eye every four shots, ensuring the laser probe always remains in moist contact with the sclera.

Use transscleral illumination to locate the ciliary body (approximately 2.5 – 3.5 mm from the limbus). The laser delivery is transscleral. Care should be taken to avoid areas of scleral thinning or where there is heavy pigmentation at the perilimbal conjunctiva.

Laser Settings

Laser settings selection and adjustments are the responsibility of the clinician, for each patient.

General power settings are 1250 mW for 4000 milliseconds for darkly pigmented irises and 1500 mW for 3500 milliseconds for lighter iris colors.

The laser probe should be held parallel to the visual axis and perpendicular to the iris plane and a series of 5 – 7 laser spots applied per quadrant with a minimum of one full spot space between each pulse.

Typically, three quadrants will be attempted, avoiding 3 & 9 o’clock positions as well as the temporal quadrant region.

Clinical data

Titre

Texte

Selective Laser Trabeculoplasty as a First-line Treatment

17/05/2023

The glaucoma surgical landscape is evolving and changing dramatically as we move forward in the era of interventional glaucoma. The interventional glaucoma mindset represents a significant paradigm shift in patient care, taking the treatment burden out of the patient’s hands and placing more emphasis on earlier laser intervention.

SLT: Positive implications from the LiGHT study

07/03/2023

Glaucoma is a lifelong disease that requires continual monitoring and management. For many patients, glaucoma can be controlled medically—at least for a time—but the treatment is far from perfect. Complications, side effects, and compliance are common issues for those who rely on eye drops to control IOP. Other barriers to medical treatment include nonresponse to a medication, tachyphylaxis, and financial burden.

SLT as Frontline Therapy

19/12/2022

Selective laser trabeculoplasty (SLT) has come a long way in the last few years. The practice is gaining adherents as a first-line treatment for open-angle glaucoma for multiple reasons. And to give SLT a boost and provide an uber-coherent overview of the reasons in favor of SLT, Dr. Paul Singh spoke on its behalf at ESCRS 2022 in Milan.

The role of Selective Laser Trabeculoplasty as a primary and secondary treatment

04/03/2022

Glaucoma is the most common optic neuropathy. The only clinically proven treatment is to reduce IOP by using medical, laser, and surgical therapies. Treatment is typically selected depending on the level of IOP, stage of the disease, pace of progression, and current and past treatment history. Glaucoma management with drops can be problematic, mainly because they can be difficult for patients to instill properly and because of the related side effects.

Selective Laser Trabeculoplasty: A Safe and Effective First-line Therapy for Glaucoma

09/06/2021

In treating glaucoma, the typical route is often to prescribe medications. If topical drops fail to achieve a reduction in intraocular pressure (IOP), then the alternative is to try laser trabeculoplasty, and finally surgery.

Let There Be (Laser) Light

09/05/2021

From 2019 to 2020, I co-chaired the European Glaucoma Society (EGS) Guidelines Committee with Carlo Traverso. The 5th Edition of the EGS guidelines was published in October 2020, after a superb team effort among a large number of colleagues (1). We aimed to promote evidence-based clinical practice and, to that end, followed GRADE methodology, including identification of key questions, critical evaluation of published literature, and formulation of recommendations.

Ranking Laser in Glaucoma Treatment

09/02/2021

Glaucoma management has traditionally taken a stepped approach based on the level of risk involved. The low-risk treatment option is medication. Next are laser/selective laser trabeculoplasty (SLT), MIGS, and incisional surgery. It ends with the highest risk option of cyclodestructive procedures.

Terminology and Guidelines for Glaucoma

18/11/2020

Download the EGS Guidelines on the European Glaucoma Society website.

Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial (LiGHT)

18/10/2020

To compare visual field outcomes of ocular hypertensive and glaucoma patients treated first with medical therapy with those treated first with selective laser trabeculoplasty (SLT).

SLT earns a place as first-line therapy

09/03/2020

Glaucoma specialists have traditionally viewed topical therapy as first-line treatment for glaucoma. Recently, however, this paradigm has been challenged. Selective laser trabeculoplasty (SLT), though FDA approved since 2001, has gained acceptance as first-line treatment over the last 5 to 10 years.

Selective Laser Trabeculoplasty Updates and Tips

09/09/2018

The glaucoma surgical landscape is bombarded with a variety of new microinvasive glaucoma surgery (MIGS) procedures daily. These new procedures are altering the paradigm and treatment concepts of glaucoma surgery and are accelerating the importance of earlier surgical intervention aimed at reducing morbidity of progression, reducing the need for more aggressive surgical options (while preserving those options), and reducing the burden of medication along with patientcompliance issues, which is one of the most prevalent problems in glaucoma treatment today.

Selective Trabeculoplasty in the Management of Open Angle Glaucoma: Retrospective Analysis at 1 Year

09/12/2017

In order to prevent the progressive and irreversible loss of optic nerve fibres, the treatment of glaucoma aims to effectively and lastingly reduce Intraocular Pressure (IOP) in affected patients. To this end, in addition to medical and surgical techniques, means of weakening the trabeculum by laser have been developed since the 1980s, following the pilot study by Wise and Witter.

Overcoming barriers to SLT as first line therapy for POAG & OH – Prof. Gus GAZZARD

12/10/2023

In this video, Prof. Gus GAZZARD , explains how to overcome barriers to SLT as first line therapy for POAG & OH. This video is from our symposium held at ESCRS 2023.

SLT as a first line treatment: Which patients are likely to benefit the most

19/09/2022

Dr Paul Singh explains what type of patients can benefit from SLT to treat glaucoma.

Selective Laser Trabeculoplasty

03/05/2022

Dr Franck Howes, Eye & Laser Centre Gold Coast (Australia) made a presentation on SLT (Selective Laser Trabeculoplasty) and detailed the process of applying laser energy for the control of glaucoma.

Why SLT should be first-line treatment?

09/09/2021

Dr Guz Gazzard

Selective Laser Trabeculoplasty: A Safe and Effective First-line Therapy for Glaucoma

09/08/2021

Dr Paul Singh

SLT laser treatment: New data

09/07/2021

Dr Jimmy Lai

SLT: A clinically proven first-line treatment

09/10/2020

Prof Mark Latina

Where should laser rank in the glaucoma treatment protocol?

09/03/2020

Prof. Mark Latina

How are glaucoma lasers different from each other?

09/03/2020

Dr. Jaromir Wasyluk

A clinically proven safe and effective first line treatment

09/10/2019

Dr Yves Lachkar

Laser Trabeculoplasty – Update and Tips

09/09/2018

Prof Mark Latina

SLT as first-line therapy for POAG & OH – Prof. Gus Gazzard

27/02/2024

In this interview, Prof. Gus Gazzard explains how SLT can be the first-line therapy for all open angle, glaucoma and ocular hypertension.

SLT laser treatment for glaucoma – Paul Singh, MD

05/01/2023

In this interview, Inder Paul Singh, MD, explains the interest of using SLT as first line therapy for glaucoma instead of medication and the impact on the ocular surface. "SLT not only takes away the compliance issues that are so difficult for us but it actually addresses the pathology directly."

SLT and the Refractive Surgeon – Video Interview with Dr Matthias Maus

16/06/2013

The glaucoma medications used to control the IOP of refractive patients often add to the blurred vision experienced by these patients on a daily basis. This leaves the refractive surgeon with the frustrating task of correcting refractive error without being able to eliminate a key contributor to the problem. In this Video interview, Matthias Maus, MD, one of Germany's leading refractive surgeons, addresses how SLT the role of SLT as an effective first-line glaucoma treatment for these patients, whilst eliminating the need for troublesome medications. Watch the video to learn more.

Overcoming barriers to SLT as first line therapy for POAG & OH – Prof. Gus GAZZARD

12/10/2023

In this video, Prof. Gus GAZZARD , explains how to overcome barriers to SLT as first line therapy for POAG & OH. This video is from our symposium held at ESCRS 2023.

SLT as a first line treatment: Which patients are likely to benefit the most

19/09/2022

Dr Paul Singh explains what type of patients can benefit from SLT to treat glaucoma.

Selective Laser Trabeculoplasty

03/05/2022

Dr Franck Howes, Eye & Laser Centre Gold Coast (Australia) made a presentation on SLT (Selective Laser Trabeculoplasty) and detailed the process of applying laser energy for the control of glaucoma.

Why SLT should be first-line treatment?

09/09/2021

Dr Guz Gazzard

Selective Laser Trabeculoplasty: A Safe and Effective First-line Therapy for Glaucoma

09/08/2021

Dr Paul Singh

SLT laser treatment: New data

09/07/2021

Dr Jimmy Lai

SLT: A clinically proven first-line treatment

09/10/2020

Prof Mark Latina

Where should laser rank in the glaucoma treatment protocol?

09/03/2020

Prof. Mark Latina

How are glaucoma lasers different from each other?

09/03/2020

Dr. Jaromir Wasyluk

A clinically proven safe and effective first line treatment

09/10/2019

Dr Yves Lachkar

Laser Trabeculoplasty – Update and Tips

09/09/2018

Prof Mark Latina

Physicians

Talk about ThermoCyclo Laser therapy

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Clinical References

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SUBCYCLO THERAPY

SUBCYCLO THERAPY

Since 1993, Quantel Medical develops, manufactures and markets innovative medical laser and ultrasound solutions.

World leader in ophthalmology, its lasers and ultrasounds are designed to diagnose and treat the four main causes of blindness: cataracts, glaucoma, diabetic retinopathy and macular degeneration; and also dry eye disease.

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