Contact transscleral neodymium:yttrium–aluminum–garnet laser cyclophotocoagulation: Long-term outcome

Abstract

Contact transscleral neodymium:yttrium-aluminum-garnet (Nd:YAG) laser cyclophotocoagulation (CYC) is a treatment option for advanced glaucoma refractory to alternative treatments. This study determined the long-term efficacy and risks of contact transscleral Nd:YAG laser CYC. A prospective study was performed with patients with advanced, uncontrolled glaucoma who received CYC from 1988 through 1989. Records for 68 eyes of 64 patients were obtained and reviewed for the 10-year follow-up. A transscleral continuous-wave Nd:YAG laser was used for photocoagulation of the ciliary body. Intraocular pressure (IOP), visual acuity, and second intervention. Failure was defined as the need for second intervention, IOP of more than 25 mmHg, or IOP of less than 3 mmHg. The mean follow-up period was 5.85+/-4.0 years (range, 0.1-10 years). The mean preoperative IOP of 36.3+/-10.1 mmHg decreased to 22.6+/-11.3 mmHg at 1 year of follow-up (P<0.001). The mean postoperative IOP at 5 years was 21.8+/-13.3 mmHg (P<0.001) and was 18.9+/-12.2 mmHg at 10 years of follow-up (P<0.001). A second intervention after CYC was required in 30 eyes (44.1%). Six eyes (8.8%) with initial visual acuity of counting fingers or worse progressed to no light perception, and 5 of 8 eyes (62.5%) with visual acuity better than 20/200 lost 2 or more Snellen lines. Hypotony developed in 3 eyes (4.4%). Overall, the failure rate by 10 years of follow-up was 51.5% (35/68 eyes). Cyclophotocoagulation resulted in a significant reduction of IOP after surgery at 1, 5, and 10 years of follow-up; however, 51.5% of eyes failed by the end of 10 years, with most failures occurring within the first year (40%). Although CYC provides a useful method to lower IOP significantly, this study suggests that its success in controlling IOP is tempered by its failure rate and risk of complications, including visual loss, phthisis, and loss of light perception.