Trans-scleral diode laser cyclophotocoagulation for refractory glaucoma after high-risk penetrating keratoplasty.

Abstract

To analyze the intraocular pressure reduction, number of anti-glaucoma medications needed, and post-operative complications of trans-scleral diode laser cyclophotocoagulation (DCPC) in patients with high-risk penetrating keratoplasty (PKP) and secondary refractory glaucoma. Prospective interventional, longitudinal, non-comparative series of cases, including 16 eyes of 15 patient's post-PKP on maximal anti-glaucoma medical therapy with intraocular pressures above 22mmHg. All patients received 18 shots, 360° peri-limbal (avoiding the long posterior ciliary nerves and arteries at 3 and 9 o'clock positions) of trans-scleral DCPC (2000mW, time: 2.0s/shot). There was a 55.5% reduction (total of 14.0mmHg) of the mean pre-operative IOP (31.5mmHg) after the first diode laser application (p=0.0020). Re-treatment was required in 31.2% of eyes over a mean period of 10.7months. In these five eyes, the mean pre-operative IOP was 40.4mmHg, which decreased to 15.0mmHg post-therapy, and a mean IOP reduction of 25.4mmHg (p=0.0218). There was a 51.0% reduction in the mean number of medications used after the first, and a 57.1% reduction after a second laser application. The incidence of failure (IOP≥22mmHg or need of additional medical therapy) from initial intervention to loss of follow-up was 1.3% per person-month. DCPC effectively reduces the intraocular pressure and the number of anti-glaucoma medications with few complications in patients after high-risk PKP and secondary glaucoma. Only, one-third of the eyes needed a second intervention to control the intraocular pressure. Post-DCPC complications were limited to phthisis bulbi and endothelial dysfunction, one eye each. Please check and confirm the author names and initials are correct. Also, kindly confirm the details in the metadata are correct.