A Comparison between Tube Surgery, ND:YAG Laser and Diode Laser Cyclophotocoagulation in the Management of Refractory Glaucoma

Philip A Bloom,Kamal Sharma,Colin I Clement,Anthony King,Peng T Khaw,Baha Noureddin,Roger A Hitchings

doi:10.1155/2013/371951

Abstract

Purpose. To compare the results of intraocular pressure (IOP) reduction by 3 treatment modalities, (a) glaucoma tube implants, (b) noncontact YAG laser cyclophotocoagulation (cycloYAG), and (c) contact transscleral diode laser cyclophotocoagulation (cyclodiode), in cases of advanced glaucoma refractory to alternative treatments. Methods. A consecutive group of 45 eyes that received cycloYAG were matched against two control groups of patients who had received tube surgery or cyclodiode, each control group having been derived from a database of patients. Results. Mean pretreatment IOP improved from 41.3, 38.6, and 32.0 mmHg for the tube, cycloYAG, and cyclodiode groups, respectively, to 16.4, 22.1, and 19.3 mmHg, respectively. Treatment success was achieved in 78%, 69%, and 71% of the tube, cycloYAG, and cyclodiode groups, respectively. Visual acuity deteriorated 2 or more Snellen lines in 16%, 7%, and 9% of the patients in the tube, cycloYAG, and cyclodiode groups, respectively. Complications included retinal detachment, hypotony, and phthisis. Conclusions. All 3 methods provided acceptable IOP lowering in the short and medium term. Control of IOP was best in patients receiving tube surgery. Cyclodiode and cycloYAG treatments were similarly effective in lowering IOP. Tube surgery was associated with a greater incidence of sight threatening complications.

Highlights

Treatment options for refractory glaucoma include methods of increasing aqueous outflow, either by antimetabolite augmented trabeculectomy or by the use of aqueous drainage shunts that allow release of fluid from the anterior chamber into the subconjunctival space
An alternative approach to lower intraocular pressure (IOP) is to reduce aqueous production from the ciliary body. This was originally carried out using cryotherapy [8], but more recently contact and noncontact transscleral cyclophotocoagulation has been popularised, initially with ND:YAG laser and more recently with diode laser [9,10,11,12,13,14,15,16,17]
A variety of methods exist for the treatment of patients in whom initial medical, laser, and surgical treatments have been unsuccessful in lowering IOP and thereby halting the progression of glaucomatous damage

Summary

Introduction

Treatment options for refractory glaucoma include methods of increasing aqueous outflow, either by antimetabolite augmented trabeculectomy or by the use of aqueous drainage shunts that allow release of fluid from the anterior chamber into the subconjunctival space. An alternative approach to lower intraocular pressure (IOP) is to reduce aqueous production from the ciliary body. This was originally carried out using cryotherapy [8], but more recently contact and noncontact transscleral cyclophotocoagulation has been popularised, initially with ND:YAG laser (cycloYAG) and more recently with diode laser (cyclodiode) [9,10,11,12,13,14,15,16,17]. The use of the diode laser has the theoretical advantage of good penetration and absorption by the tissues of the ciliary body [18,19,20]. The treatments were compared for (1) effect on visual acuity, (2) IOP control, (3) effect of age, (4) subsequent management of IOP control (medical, surgical, and laser), (5) complications, and (6) costs of treatment

Methods

Results

Discussion

Conclusion