Contact transscleral cyclophotocoagulation with diode laser in refractory glaucoma.

Abstract

To evaluate the clinical effectiveness of contact transscleral cyclophotocoagulation (CTCP) with diode laser. Forty-eight seeing eyes and 20 blind and painful eyes of 68 patients suffering from refractory glaucoma were treated using a diode laser (EOS3000, Laser Science) coupled with a 400-microns optic fiber ending in a 3-mm focusing tip. Sixteen to twenty 3.9-J (2.6 W x 1.5 to 2.5 s) laser spots were placed over 360 degrees, 1.5 mm from the corneolimbal junction. In the seeing-eye group, the follow-up was 20.7 +/- 8.14 months, pre- and posttreatment IOPs were 37.1 +/- 11.27 and 19.5 +/- 8.73 mmHg respectively (p < 0.0001), and success (IOP > 2 and < or = 21 mmHg) was 70.8%. No significant visual acuity change was found in the successful eyes, whereas a significant visual acuity reduction was found in the unsuccessful cases (p = 0.03). In the blind-eye group, the follow-up was 20.5 +/- 8.54 months, pre- and post-treatment IOPs were 50.7 +/- 15.05 and 20.6 +/- 13.99 mmHg respectively (p < 0.0001), and success (remission of pain) was 100%. As for complications, one seeing eye developed a spontaneously-resolved vitreous hemorrhage and one seeing and one blind eye became hypotonic, though no phthysis was observed. No conjunctival or lens damage was detected, and no scleral thinning was revealed by ultrasound biomicroscopy. No case of sympathetic ophthalmia was found. Diode laser can be successfully employed for CTCP in refractory glaucoma.