SubCyclo for advanced glaucoma treatment
What is SubCyclo ? A second line treatment
SubCyclo® is a new, non-destructive laser procedure for the treatment of moderate to advanced glaucoma.
Based on a similar principle as transscleral cyclophotocoagulation, TSCPC, it employs an 810 nm laser wavelength for SubLiminal® stimulation of the ciliary body, limiting the production of aqueous humor, and remodeling the uveoscleral pathway, improving this secondary route of aqueous outflow.
Due to its improved safety profile SubCyclo may be used in seeing eyes with good visual potential 1 2 SubCyclo mechanisms of action are hypothesized to be :
1
Changes in the extracellular matrix causing a decreased resistance to uveoscleral aqueous outflow.
2
Slight inflammation of the ciliary body, decreasing production of aqueous humor.
3
Contraction of ciliary muscle, opening the anterior chamber angle, leading to an Increase of the trabecular outflow, (equivalent to a pilocarpine effect).
Indications for SubCyclo® laser include advanced glaucoma which has not responded to other therapeutic or surgical interventions, moderate glaucoma, where there is contraindication to filtration surgery, intolerance to medication, palliative care, and in preparation for another procedure requiring an urgent IOP reduction such as cataract surgery.
Topical prednisolone acetate 1% was prescribed 4 times a day for 1-2 weeks post-laser.
Technology
SubCyclo laser is a modern subthreshold laser treatment procedure. It is performed using the Quantel Medical Vitra 810 SubLiminal laser combined with the Quantel Medical SubCyclo® probe with footplate detached.
Tightly controlled short-duration micro-second laser pulses are delivered in a duty-cycled pulse train, where the laser off time is greater than laser on-time, preventing the build-up and dispersal of heat energy into surrounding tissue.
It is a non-invasive out-patient procedure, administered under local anaesthetic, and can be performed in the OR in just a few minutes.
Treatment guidelines
Always use the appropriately rated safety eyewear when operating a laser. Following their clinical research at the Glaucoma Institute, Saint Joseph Hospital, Paris (FRANCE), Drs Nassima BENHATCHI and Yves LACHKAR compiled effective SubCyclo® treatment guidelines.
These guidelines facilitate safe delivery of SubCyclo® laser therapy for the treatment of moderate to end-stage glaucoma.
Clinical data
A new treatment for advanced and end-stage glaucoma
Primary angle glaucoma, primary angle closure glaucoma, pseudo-exfoliation, neovascular glaucoma, glaucoma associated with steroid uses, uveitis and after keratoplasty surgery 2 3
A very efficient non thermal procedure leading to a reduction in the medication regimen 2 4
Significant and persistent reduction in IOP at 12 months2
Mean number of medication
• Before treatment: 3,4 ± 1,7
• After treatment: 2,9 ± 1,6
30 % decrease from baseline and less than 21 mmHg
SubCyclo® preserves the structures of the ciliary body (no destructive effects) and improves the uveoscleral drainage
After treatment:
No anatomical damage or visible lesion have been observed by ultrasound biomicroscopy2
UBM shows a thin space between sclera and ciliary body which may correspond to the presence of suprachoroidal fluid2
SubCyclo® avoids the side effects of the thermal cyclophotocoagulation procedure
No serious side effects such as intraocular inflammation after treatment 2
No severe complications such as phthisis bulbi, persistent hypotony, or cystoid macular edema 2
A repeatable treatment 2 4
A safe treatment potentially allowing for earlier laser interventions
Subliminal Cyclophotocoagulation
Ranking Laser in Glaucoma Treatment
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Glaucoma Lasers of Today and How They Differ
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Comparative Effectiveness and Tolerance of Subliminal Subthreshold Transscleral Cyclophotocoagulation With a Duty Factor of 25% Versus 31.3% for Advanced Glaucoma
SubLiminal Cyclophotocoagulation: A New Perspective
Benefits of SubCyclo Laser Therapy Guided by High-frequency Ultrasound Biomicroscopy in Patients With Refractory Glaucoma
Subcyclo laser procedure results in patients with glaucoma
Significant Improvements for IOP Reduction Seen in SubCyclo
Physicians
Talk about SubCyclo Laser therapy
Clinical References
1 Barac R, et al., 2018: Choroidal Thickness increase after Micropulse Transscleral Cyclophotocoagulation
2 Benhatchi N, Bensmail D, Lachkar Y. Benefits of SubCyclo laser therapy guided by high frequency ultrasound biomicroscopy in patients with refractory glaucoma. J Glaucoma 2019 Jun;28(6):535 539
3 Keilani C, Benhatchi N, Bensmail D, Abitbol O, Amara A, Bluwol E, Graber M, Lachkar Y. Comparative effectiveness and tolerance of subliminal subthreshold transscleral cyclophotocoagulation with a duty factor of 25% versus 31.3% for advanced glaucoma. J Glaucoma. 2020 Feb;29(2):97-103
4 Lutic I, Dragne C, Filip M, Filip A, Nicolae M, Moisescu R, Ungureanu I, Triantafyllidis G, Antonescu C. Subcyclo laser procedure results in patients with glaucoma. Rom J Ophthalmol. 2018 Oct-Dec;62(4):296-299
5 Agrawal P, Martin KR. Ciliary body position variability in glaucoma patients assessed by scleral transillumination. Eye. 2008;22:1499–1503.