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Clinically Successful Contact Transscleral Krypton Laser Cyclophotocoagulation: Long-term Histopathologic and Immunohistochemical Autopsy Findings

Clinically Successful Contact Transscleral Krypton Laser Cyclophotocoagulation: Long-term... Abstract Objective: To report long-term histopathologic findings 10 months after contact transscleral krypton cyclophotocoagulation. Methods: The tissue response in a successfully treated eye was analyzed by light microscopy and a panel of 11 antibodies to epithelial, mesenchymal, and inflammatory cells. Results: A 75-year-old man with uncontrolled angle recession glaucoma was treated with transscleral contact krypton cyclophotocoagulation (17 burns, 3.5 J each) 10 months before his death. The intraocular pressure fell from 28 to 17 mm Hg 6 months after therapy. Confluent scars straddled the posterior pars plicata and the anterior pars plana. The ciliary processes were destroyed, but the sclera and zonules were intact. Vimentin and cytokeratin 8 and 18 persisted in the degenerated ciliary epithelium. The inner connective-tissue layer and the ciliary muscle had atrophied, as shown with antibodies to the HNK-1 epitope, desmin, and α—smooth-muscle actin. Macrophages with phagocytized pigment and single T cells were present instead. No unusual inflammatory infiltrate was present in the choroid of either eye. Conclusions: Clinically effective ablation of ciliary processes is achieved with contact krypton laser. Little chronic inflammation and no signs of sympathetic ophthalmia were present. Atrophy of the ciliary muscle may reduce accommodative capacity in younger patients undergoing cyclophotocoagulation. References 1. References 1, 13, 14, 16, 18, 19, 26, 28, 31, and 32. 2. Beckman H, Kinoshita A, Rota AN, Sugar HS. Transscleral ruby laser irradiation of the ciliary body in the treatment of intractable glaucoma . Trans Am Acad Ophthalmol Otolaryngol . 1972;76:423-436. 3. Kalenak JW, Parkinson JM, Kass MA, Kolker AE. Transscleral neodymium: YAG laser cyclocoagulation for uncontrolled glaucoma . Ophthalmic Surg . 1990;21:346-351. 4. McAllister J, O'Brien C. Neodymium:YAG transscleral cyclocoagulation: a clinical study . Eye . 1990;4:651-656.Crossref 5. Hampton C, Shields MB, Miller KN, Blasini M. Evaluation of a protocol for transscleral neodymium:YAG cyclophotocoagulation in one hundred patients . Ophthalmology . 1990;97:910-917.Crossref 6. Brooks AMV, Gillies WE. The use of YAG cyclophotocoagulation to lower pressure in advanced glaucoma . Aust N Z J Ophthalmol . 1991;19:207-210.Crossref 7. Heidenkummer H-P, Mangouritsas G, Kampik A. Klinische Anwendung und Ergebnisse der transskleralen Nd-YAG Zyklophotokoagulation bei therapierefraktärem Glaukom . Klin Monatsbl Augenheilkd . 1991;198:174-180.Crossref 8. Schuman JS, Bellows AR, Shingleton BJ, et al. Contact transscleral Nd:YAG laser cyclophotocoagulation: midterm results . Ophthalmology . 1992;99:1089-1095.Crossref 9. Hawkins TA, Stewart WC. One-year results of semiconductor transscleral cyclophotocoagulation in patients with glaucoma . Arch Ophthalmol . 1993;111:488-491.Crossref 10. Immonen IJR, Puska P, Raitta C. Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma . Ophthalmology . 1994;101:876-882.Crossref 11. Assia El, Hennis HL, Stewart WC, Legler UFC, Carlson AN, Apple DJ. A comparison of neodymium:yttrium aluminum garnet and diode laser transscleral cyclophotocoagulation and cyclocryotherapy . Invest Ophthalmol Vis Sci . 1991;32:2774-2778. 12. Brancato R, Leoni G, Trabucchi G, Cappellini A. Histopathology of continuous wave neodymium:yttrium aluminum garnet and diode laser contact transscleral lesions in rabbit ciliary body: a comparative study . Invest Ophthalmol Vis Sci . 1991;32:1586-1592. 13. Immonen I, Suomalainen V-P, Kivelä T, Viherkoski E. Energy levels needed for cyclophotocoagulation: a comparison of transscleral contact CW-YAG and krypton lasers in the rabbit eye . Ophthalmic Surg . 1993;24:530-533. 14. Devenyi RG, Trope GE, Hunter WH. Neodymium-YAG transscleral cyclocoagulation in rabbit eyes . Br J Ophthalmol . 1987;71:441-444.Crossref 15. Schubert HD, Federman JL. A comparison of CW Nd:YAG contact transscleral cyclophotocoagulation with cyclocryopexy . Invest Ophthalmol Vis Sci . 1989;30:536-542. 16. Schubert HD, Federman JL. The role of inflammation in CW Nd:YAG contact transscleral photocoagulation and cryopexy . Invest Ophthalmol Vis Sci . 1989;30:543-549. 17. Nasisse MP, McGahan MC, Shields MB, Echelman D, Fleisher LN. Inflammatory effects of continuous-wave neodymium:yttrium aluminum garnet laser cyclophotocoagulation . Invest Ophthalmol Vis Sci . 1992;33:2216-2223. 18. Echelman DA, Nasisse MP, Shields MB, McGahan MC, Fleisher LN. Influence of exposure time on inflammatory response to neodymium:YAG cyclophotocoagulation in rabbits . Arch Ophthalmol . 1994;112:977-981.Crossref 19. Coleman AL, Jampel HD, Javitt JC, Brown AE, Quigley HA. Transscleral cyclophotocoagulation of human autopsy and monkey eyes . Ophthalmic Surg . 1991;22:638-643. 20. Liu G-J, Mizukawa A, Okisaka S. Mechanism of intraocular pressure decrease after contact transscleral continuous-wave Nd:YAG laser cyclophotocoagulation . Ophthalmic Res . 1994;26:65-79.Crossref 21. Hampton C, Shields MB. Transscleral neodymium-YAG cyclophotocoagulation: a histologic study of human autopsy eyes . Arch Ophthalmol . 1988;106:1121-1123.Crossref 22. Schubert HD. Noncontact and contact pars plana transscleral neodymium: YAG laser cyclophotocoagulation in postmortem eyes . Ophthalmology . 1989;96:1471-1475.Crossref 23. Schubert HD, Agarwala A, Arbizo V. Changes in aqueous outflow after in vitro neodymium:yttrium aluminum garnet laser cyclophotocoagulation . Invest Ophthalmol Vis Sci . 1990;31:1834-1838. 24. Bloom M, Weber PA. Probe orientation in contact Nd:YAG laser cyclophotocoagulation . Ophthalmic Surg . 1992;23:364-366. 25. Prum BE Jr, Shields SR, Simmons RB, Echelman DA, Shields MB. The influence of exposure duration in transscleral Nd:YAG laser cyclophotocoagulation . Am J Ophthalmol . 1992;114:560-567. 26. Simmons RB, Prum BE Jr, Shields SR, Echelman DA, Shields MB. Videographic and histologic comparison of Nd:YAG and diode laser contact transscleral cyclophotocoagulation . Am J Ophthalmol . 1994;117:337-341. 27. Brancato R, Leoni G, Trabucchi G, Capellini A. Probe placement and energy levels in continuous wave neodymium-YAG contact transscleral cyclophotocoagulation . Arch Ophthalmol . 1990;108:679-683.Crossref 28. Blasini M, Simmons R, Shields MB. Early tissue response to transscleral neodymium:YAG cyclophotocoagulation . Invest Ophthalmol Vis Sci . 1990;31:1114-1118. 29. Balacco-Gabrieli C, Picardo V, Trecina T, Chetri A, Colonna GB. Efficacy of transscleral neodymium:yttrium aluminum garnet laser cyclophotocoagulation in the treatment of secondary glaucomas: personal experience and histologic contribution . Glaucoma . 1993;15:132-136. 30. Shields SM, Stevens JL, Kass MA, Smith ME. Histopathologic findings after Nd:YAG transscleral cyclophotocoagulation . Am J Ophthalmol . 1988;106:100-101. 31. Edward DP, Brown SVL, Higginbotham E, Jennings T, Tessler HH, Tso MOM. Sympathetic ophthalmia following neodymium:YAG cyclotherapy . Ophthalmic Surg . 1989;20:544-546. 32. March WF, Shaver RP. Histologic effects of cyclophotocoagulation . Ophthalmology . 1989;96:925.Crossref 33. Marsh P, Wilson DJ, Samples JR, Morrison JC. A clinicopathologic correlative study of noncontact Nd:YAG cyclophotocoagulation . Am J Ophthalmol . 1993;115:597-602. 34. Bechrakis NE, Müller-Stolzenburg NW, Helbig H, Foerster MH. Sympathetic ophthalmia following laser cyclocoagulation . Arch Ophthalmol . 1994;112:80-84.Crossref 35. Kivelä T, Fuchs U, Tarkkanen A. Cytoskeleton in neuroectodermally derived epithelial and muscle cells of the human iris and ciliary body . J Histochem Cytochem . 1992;40:1517-1526.Crossref 36. Uusitalo M, Kivelä T, Tarkkanen A. Identification of a novel element in the human eye: the inner connective tissue layer of the ciliary body characterized with antibodies to the HNK-1 epitope . Invest Ophthalmol Vis Sci . 1993;34:2372-2381. 37. Uusitalo M. Immunohistochemical localization of chondroitin sulfate proteoglycan and tenascin in the human eye as compared to the HNK-1 epitope . Graefes Arch Clin Exp Ophthalmol . 1994;232:657-665.Crossref 38. Warnke RA, Gatter KC, Falini B, et al. Diagnosis of human lymphoma with monoclonal antileukocyte antibodies . N Engl Med J . 1983;309:1275-1281.Crossref 39. Smith SH, Brown MH, Rowe D, Callard RE, Beverley PCL. Functional subsets of human helper-inducer cells defined by a new monoclonal antibody, UCHL1 . Immunology . 1986;58:63-70. 40. Falini B, Flenghi L, Pileri R, et al. PG-M1: a new monoclonal antibody directed against a fixative-resistant epitope on the macrophage-restricted form of the CD68 molecule . Am J Pathol . 1993;142:1359-1372. 41. Streilein JW. Anterior chamber associated immune deviation: the privilege of immunity in the eye . Surv Ophthalmol . 1990;35:67-73.Crossref 42. Rocha G, Baines MG, Deschênes J. The immunology of the eye and its systemic interactions . Crit Rev Immunol . 1992;12:81-100. 43. Brown SVL, Higginbotham E, Tessler H. Sympathetic ophthalmia following Nd: YAG cyclotherapy . Ophthalmic Surg . 1990;21:736-737. 44. Lam S, Tessler HH, Lam BL, Wilensky JT. High incidence of sympathetic ophthalmia after contact and noncontact neodymium:YAG cyclotherapy . Ophthalmology . 1992;99:1818-1822.Crossref 45. Pastor SA, Iwach A, Nozik RA, Hetherington J, Fellman R. Presumed sympathetic ophthalmia following Nd:YAG transscleral cyclophotocoagulation . J Glaucoma . 1993;2:30-31. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Clinically Successful Contact Transscleral Krypton Laser Cyclophotocoagulation: Long-term Histopathologic and Immunohistochemical Autopsy Findings

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1995.01100110107033
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To report long-term histopathologic findings 10 months after contact transscleral krypton cyclophotocoagulation. Methods: The tissue response in a successfully treated eye was analyzed by light microscopy and a panel of 11 antibodies to epithelial, mesenchymal, and inflammatory cells. Results: A 75-year-old man with uncontrolled angle recession glaucoma was treated with transscleral contact krypton cyclophotocoagulation (17 burns, 3.5 J each) 10 months before his death. The intraocular pressure fell from 28 to 17 mm Hg 6 months after therapy. Confluent scars straddled the posterior pars plicata and the anterior pars plana. The ciliary processes were destroyed, but the sclera and zonules were intact. Vimentin and cytokeratin 8 and 18 persisted in the degenerated ciliary epithelium. The inner connective-tissue layer and the ciliary muscle had atrophied, as shown with antibodies to the HNK-1 epitope, desmin, and α—smooth-muscle actin. Macrophages with phagocytized pigment and single T cells were present instead. No unusual inflammatory infiltrate was present in the choroid of either eye. Conclusions: Clinically effective ablation of ciliary processes is achieved with contact krypton laser. Little chronic inflammation and no signs of sympathetic ophthalmia were present. Atrophy of the ciliary muscle may reduce accommodative capacity in younger patients undergoing cyclophotocoagulation. References 1. References 1, 13, 14, 16, 18, 19, 26, 28, 31, and 32. 2. Beckman H, Kinoshita A, Rota AN, Sugar HS. Transscleral ruby laser irradiation of the ciliary body in the treatment of intractable glaucoma . Trans Am Acad Ophthalmol Otolaryngol . 1972;76:423-436. 3. Kalenak JW, Parkinson JM, Kass MA, Kolker AE. Transscleral neodymium: YAG laser cyclocoagulation for uncontrolled glaucoma . Ophthalmic Surg . 1990;21:346-351. 4. McAllister J, O'Brien C. Neodymium:YAG transscleral cyclocoagulation: a clinical study . Eye . 1990;4:651-656.Crossref 5. Hampton C, Shields MB, Miller KN, Blasini M. Evaluation of a protocol for transscleral neodymium:YAG cyclophotocoagulation in one hundred patients . Ophthalmology . 1990;97:910-917.Crossref 6. Brooks AMV, Gillies WE. The use of YAG cyclophotocoagulation to lower pressure in advanced glaucoma . Aust N Z J Ophthalmol . 1991;19:207-210.Crossref 7. Heidenkummer H-P, Mangouritsas G, Kampik A. Klinische Anwendung und Ergebnisse der transskleralen Nd-YAG Zyklophotokoagulation bei therapierefraktärem Glaukom . Klin Monatsbl Augenheilkd . 1991;198:174-180.Crossref 8. Schuman JS, Bellows AR, Shingleton BJ, et al. Contact transscleral Nd:YAG laser cyclophotocoagulation: midterm results . Ophthalmology . 1992;99:1089-1095.Crossref 9. Hawkins TA, Stewart WC. One-year results of semiconductor transscleral cyclophotocoagulation in patients with glaucoma . Arch Ophthalmol . 1993;111:488-491.Crossref 10. Immonen IJR, Puska P, Raitta C. Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma . Ophthalmology . 1994;101:876-882.Crossref 11. Assia El, Hennis HL, Stewart WC, Legler UFC, Carlson AN, Apple DJ. A comparison of neodymium:yttrium aluminum garnet and diode laser transscleral cyclophotocoagulation and cyclocryotherapy . Invest Ophthalmol Vis Sci . 1991;32:2774-2778. 12. Brancato R, Leoni G, Trabucchi G, Cappellini A. Histopathology of continuous wave neodymium:yttrium aluminum garnet and diode laser contact transscleral lesions in rabbit ciliary body: a comparative study . Invest Ophthalmol Vis Sci . 1991;32:1586-1592. 13. Immonen I, Suomalainen V-P, Kivelä T, Viherkoski E. Energy levels needed for cyclophotocoagulation: a comparison of transscleral contact CW-YAG and krypton lasers in the rabbit eye . Ophthalmic Surg . 1993;24:530-533. 14. Devenyi RG, Trope GE, Hunter WH. Neodymium-YAG transscleral cyclocoagulation in rabbit eyes . Br J Ophthalmol . 1987;71:441-444.Crossref 15. Schubert HD, Federman JL. A comparison of CW Nd:YAG contact transscleral cyclophotocoagulation with cyclocryopexy . Invest Ophthalmol Vis Sci . 1989;30:536-542. 16. Schubert HD, Federman JL. The role of inflammation in CW Nd:YAG contact transscleral photocoagulation and cryopexy . Invest Ophthalmol Vis Sci . 1989;30:543-549. 17. Nasisse MP, McGahan MC, Shields MB, Echelman D, Fleisher LN. Inflammatory effects of continuous-wave neodymium:yttrium aluminum garnet laser cyclophotocoagulation . Invest Ophthalmol Vis Sci . 1992;33:2216-2223. 18. Echelman DA, Nasisse MP, Shields MB, McGahan MC, Fleisher LN. Influence of exposure time on inflammatory response to neodymium:YAG cyclophotocoagulation in rabbits . Arch Ophthalmol . 1994;112:977-981.Crossref 19. Coleman AL, Jampel HD, Javitt JC, Brown AE, Quigley HA. Transscleral cyclophotocoagulation of human autopsy and monkey eyes . Ophthalmic Surg . 1991;22:638-643. 20. Liu G-J, Mizukawa A, Okisaka S. Mechanism of intraocular pressure decrease after contact transscleral continuous-wave Nd:YAG laser cyclophotocoagulation . Ophthalmic Res . 1994;26:65-79.Crossref 21. Hampton C, Shields MB. Transscleral neodymium-YAG cyclophotocoagulation: a histologic study of human autopsy eyes . Arch Ophthalmol . 1988;106:1121-1123.Crossref 22. Schubert HD. Noncontact and contact pars plana transscleral neodymium: YAG laser cyclophotocoagulation in postmortem eyes . Ophthalmology . 1989;96:1471-1475.Crossref 23. Schubert HD, Agarwala A, Arbizo V. Changes in aqueous outflow after in vitro neodymium:yttrium aluminum garnet laser cyclophotocoagulation . Invest Ophthalmol Vis Sci . 1990;31:1834-1838. 24. Bloom M, Weber PA. Probe orientation in contact Nd:YAG laser cyclophotocoagulation . Ophthalmic Surg . 1992;23:364-366. 25. Prum BE Jr, Shields SR, Simmons RB, Echelman DA, Shields MB. The influence of exposure duration in transscleral Nd:YAG laser cyclophotocoagulation . Am J Ophthalmol . 1992;114:560-567. 26. Simmons RB, Prum BE Jr, Shields SR, Echelman DA, Shields MB. Videographic and histologic comparison of Nd:YAG and diode laser contact transscleral cyclophotocoagulation . Am J Ophthalmol . 1994;117:337-341. 27. Brancato R, Leoni G, Trabucchi G, Capellini A. Probe placement and energy levels in continuous wave neodymium-YAG contact transscleral cyclophotocoagulation . Arch Ophthalmol . 1990;108:679-683.Crossref 28. Blasini M, Simmons R, Shields MB. Early tissue response to transscleral neodymium:YAG cyclophotocoagulation . Invest Ophthalmol Vis Sci . 1990;31:1114-1118. 29. Balacco-Gabrieli C, Picardo V, Trecina T, Chetri A, Colonna GB. Efficacy of transscleral neodymium:yttrium aluminum garnet laser cyclophotocoagulation in the treatment of secondary glaucomas: personal experience and histologic contribution . Glaucoma . 1993;15:132-136. 30. Shields SM, Stevens JL, Kass MA, Smith ME. Histopathologic findings after Nd:YAG transscleral cyclophotocoagulation . Am J Ophthalmol . 1988;106:100-101. 31. Edward DP, Brown SVL, Higginbotham E, Jennings T, Tessler HH, Tso MOM. Sympathetic ophthalmia following neodymium:YAG cyclotherapy . Ophthalmic Surg . 1989;20:544-546. 32. March WF, Shaver RP. Histologic effects of cyclophotocoagulation . Ophthalmology . 1989;96:925.Crossref 33. Marsh P, Wilson DJ, Samples JR, Morrison JC. A clinicopathologic correlative study of noncontact Nd:YAG cyclophotocoagulation . Am J Ophthalmol . 1993;115:597-602. 34. Bechrakis NE, Müller-Stolzenburg NW, Helbig H, Foerster MH. Sympathetic ophthalmia following laser cyclocoagulation . Arch Ophthalmol . 1994;112:80-84.Crossref 35. Kivelä T, Fuchs U, Tarkkanen A. Cytoskeleton in neuroectodermally derived epithelial and muscle cells of the human iris and ciliary body . J Histochem Cytochem . 1992;40:1517-1526.Crossref 36. Uusitalo M, Kivelä T, Tarkkanen A. Identification of a novel element in the human eye: the inner connective tissue layer of the ciliary body characterized with antibodies to the HNK-1 epitope . Invest Ophthalmol Vis Sci . 1993;34:2372-2381. 37. Uusitalo M. Immunohistochemical localization of chondroitin sulfate proteoglycan and tenascin in the human eye as compared to the HNK-1 epitope . Graefes Arch Clin Exp Ophthalmol . 1994;232:657-665.Crossref 38. Warnke RA, Gatter KC, Falini B, et al. Diagnosis of human lymphoma with monoclonal antileukocyte antibodies . N Engl Med J . 1983;309:1275-1281.Crossref 39. Smith SH, Brown MH, Rowe D, Callard RE, Beverley PCL. Functional subsets of human helper-inducer cells defined by a new monoclonal antibody, UCHL1 . Immunology . 1986;58:63-70. 40. Falini B, Flenghi L, Pileri R, et al. PG-M1: a new monoclonal antibody directed against a fixative-resistant epitope on the macrophage-restricted form of the CD68 molecule . Am J Pathol . 1993;142:1359-1372. 41. Streilein JW. Anterior chamber associated immune deviation: the privilege of immunity in the eye . Surv Ophthalmol . 1990;35:67-73.Crossref 42. Rocha G, Baines MG, Deschênes J. The immunology of the eye and its systemic interactions . Crit Rev Immunol . 1992;12:81-100. 43. Brown SVL, Higginbotham E, Tessler H. Sympathetic ophthalmia following Nd: YAG cyclotherapy . Ophthalmic Surg . 1990;21:736-737. 44. Lam S, Tessler HH, Lam BL, Wilensky JT. High incidence of sympathetic ophthalmia after contact and noncontact neodymium:YAG cyclotherapy . Ophthalmology . 1992;99:1818-1822.Crossref 45. Pastor SA, Iwach A, Nozik RA, Hetherington J, Fellman R. Presumed sympathetic ophthalmia following Nd:YAG transscleral cyclophotocoagulation . J Glaucoma . 1993;2:30-31.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Nov 1, 1995

References

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