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).

Vitra 810 with probe

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.

Micropulse subcyclo laser therapy
SubCyclo® Laser: a modern, non-destructive, and repeatable approach to an age-old problem

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.

Glaucoma Treatment: SubCyclo Procedure

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

graphique-subcyclo
post treatment

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

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Subliminal Cyclophotocoagulation

09/02/2021
Glaucoma is a leading cause of irreversible blindness affecting approximately 60 million people globally 40 years of age and older.􀄦 Glaucoma is a disease that cannot be ignored, and the need for signi􀃶cant changes in how we diagnose, manage, and treat must be examined and applied whenever possible.

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.

Subliminal Diode Treatment of the Ciliary Bodies by Transscleral Cyclophotocoagulation with a 31.3% Duty Cycle in the Treatment of Refractory Glaucoma: Safety and Efficacy

05/02/2021
Micropulse Transscleral diode laser cyclophotocoagulation (MP-TSCPC) is an established method of treatment for refractory glaucoma. This study evaluates the efficacy in terms of reduction in intraocular pressure and/or treatment amount, and safety and side effects of the ciliary bodies using a subthreshold laser with a duty cycle of 31.3% with Supra 810 nm Subliminal Quantel Medical, at one year in patients with refractory glaucoma.

Micropulsed diode laser transscleral cyclophotocoagulation: An effective technique whose role remains to be defined

18/01/2021
Micropulse Transscleral Cyclophotocoagulation (MP-TSCP) is a recently developed cyclodestructive procedure less aggressive than conventional TSCP. In this study, we aimed to evaluate the safety and efficacy of MP-TSCP in a real-life setting.

Glaucoma Lasers of Today and How They Differ

09/10/2020
In recent years, the glaucoma treatment marketplace has been inundated with new laser technologies, which have excited physicians and surgeons as they have completely reinvented and invigorated the glaucoma treatment paradigm. Today, glaucoma is on the rise and continues to be one of the leading causes of blindness and vision loss worldwide.

SubCyclo: A New Treatment Option for Advanced and Refractory Glaucoma

09/04/2020
Origins of surgical glaucoma treatment date back to the mid 1800s when iridectomy was discovered as an effective surgical method for the treatment of acute glaucoma and sclerotomy was presented as a procedure for chronic glaucoma. Though advancements have continued to change the landscape of how to treat glaucoma, the approaches remain largely the same: relief of the pupillary block, external filtration, internal filtration, and ciliodestruction.

Comparative Effectiveness and Tolerance of Subliminal Subthreshold Transscleral Cyclophotocoagulation With a Duty Factor of 25% Versus 31.3% for Advanced Glaucoma

18/02/2020
The objective of this study was to compare the effectiveness and the tolerance of SS-TSCPC with a duty cycle of 25% versus 31.3% with Supra 810 nm Subliminal Quantel Medical laser stimulation for advanced glaucoma.

SubLiminal Cyclophotocoagulation: A New Perspective

09/12/2019
Glaucoma is a leading cause of irreversible blindness affecting approximately 60 million people globally 40 years of age and older. Glaucoma is a disease that cannot be ignored, and the need for significant changes in how we diagnose, manage, and treat must be examined and applied whenever possible.

Benefits of SubCyclo Laser Therapy Guided by High-frequency Ultrasound Biomicroscopy in Patients With Refractory Glaucoma

18/02/2019
The purpose of this study was to evaluate the efficacy and safety of subliminal cyclophotocoagulation using a 25% duty cycle diode laser (Supra 810, SubCyclo, Quantel Medical).

Subcyclo laser procedure results in patients with glaucoma

09/10/2018
To analyse the results of subCyclo (subliminal transscleral cyclophotocoagulation) laser procedure for patients with glaucoma.

Significant Improvements for IOP Reduction Seen in SubCyclo

09/06/2018
As a leading cause of irreversible blindness worldwide, glaucoma affects around 60.5 million people globally. Significant changes in diagnostic criteria, new therapies, and new tools for glaucoma management techniques have benefited individual patients

Physicians

Talk about SubCyclo Laser therapy

Pieter Gouws
Dr Pieter Gouws
puce-bleu
United Kingdom
It is safe to say that we now have a treatment modality available in SubCyclo with an excellent side effect profile that leaves us to think about how to best use this technology and in which areas we can use this gentler form of treatment.
Francesco Oddone
Dr Francesco Oddone
puce-bleu
Italy
I am convinced that ciliary body transillumination on patients undergoing SubCyclo procedures offers benefits not only in the optimal probe placement but also inthe therapeutic outcome.
Wasyluk
Dr Jaromir Wasyluk
puce-bleu
Poland
In 2021, SLT laser therapy should be considered as a preferred first line treatment for glaucoma treatment and SubCyclo favored as an alternative treatment option to surgery

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.