Transscleral cyclophotocoagulation in refractory acute and chronic angle closure glaucoma

Angle closure glaucoma, both acute and chronic, is a major cause of blindness worldwide. Transscleral cyclophotocoagulation (TSCP) is conventionally undertaken non-urgently in patients with advanced glaucoma and poor visual potential with poor control of intraocular pressure (IOP). We describe a case of a patient with refractory acute angle closure glaucoma and severe pain in whom emergency TSCP was undertaken 12 h after presentation, reducing the IOP from 68 to 10 mm Hg. Further, a patient with chronic angle closure glaucoma underwent TSCP, reducing the IOP from 78 to 14 mm Hg. Both patients consequently underwent uneventful phacoemulsification cataract surgery with preservation of visual acuity and long-term IOP control. TSCP may achieve prompt IOP control and symptomatic relief in the acute setting in patients with acute and chronic forms of angle closure glaucoma refractory to medical therapy. TSCP may reduce the risk of definitive surgical intervention by temporising phacoemulsification or trabeculectomy surgery until the IOP is well controlled.