Cyclodiode Laser Treatment Research Articles

Contact Transscleral Cyclodiode Laser Treatment for Refractory Glaucoma After Penetrating Keratoplasty: Retrospective Long-term Outcomes

To study the long-term safety and efficacy of contact TCP in eyes with refractory glaucoma after penetrating keratoplasty (PKP). All consecutive patients who were treated with TCP for refractory glaucoma following PKP between March 1996 and February 2017 in a tertiary corneal transplantation service in the United Kingdom. Only patients with a follow-up of 5 years were included. Eligible patients were identified through the corneal transplantation service database. Medical records and database data were retrospectively analyzed and compared at 5 years from baseline. In total, 28 eyes of 28 patients presented with a mean IOP of 30.4 mm Hg (SD, 7.5) at baseline despite maximally tolerated topical and systemic antiglaucoma medications. IOP was reduced significantly to 12.8 mm Hg (SD, 3.6) (P<0.0001) at 5 years with 100% of patients with a successfully controlled IOP (defined as ≤21 mm Hg). All patients had a clear graft at the beginning of the study period and at 5 years 60.7% (n=17) still presented clear grafts. The average number of topical glaucoma medication was reduced from 2.8 (SD, 0.8) to 1.7 (SD, 1.2) (P=0.019) at 5 years. Visual acuity remained stable in 67.9% of patients at 5-year endpoint. No complications (ie, hypotony or phthisis bulbi) were reported during the study period and the corneal graft failure rate remained low at 5 years (39.3%). Cyclodiode laser treatment with initial selective 180-degree protocol seems to be an efficient therapeutic option in the management of patients with refractory glaucoma post-PKP when compared with other surgical alternatives. A selective 180-degree protocol seems to potentially reduce the rate of complications. Further randomized controlled studies are needed to compare outcomes with modified treatment's protocols and glaucoma drainage device.

A retrospective analysis of long-term outcomes following a single episode of transscleral cyclodiode laser treatment in patients with glaucoma

ObjectivesTo investigate the efficacy of a single cyclodiode laser photocoagulation treatment for refractory glaucoma and its effect on visual outcome in patients with good visual potential as well as to...

The Effectiveness of Trans-scleral Cyclodiode Treatment

Transcleral cyclodiode laser treatment is increasingly being used in the management of complex glaucoma. This review discusses the literature with reference to the effectiveness of this treatment modality as well as its potential limitations.

Purified triamcinolone acetonide as antifibrotic adjunct in glaucoma filtering surgery

The purpose of this study is to compare the effects of mitomycin C (MMC) and triamcinolone acetonide (TAC) during and after glaucoma filtering surgery. Retrospective interventional consecutive case series. All eyes underwent primary guarded trabeculectomy with either MMC or sub-Tenon TAC injection. Intraoperative and postoperative complications up to 5 years after the filtering surgery were evaluated. Differences between the two regimens were tested for statistical significance. A total of 64 trabeculectomies, of which 39 with MMC and 25 with TAC, were compared. At the 5-year follow-up examination three of the eyes treated with MMC (7.7 %) and none of the eyes treated with TAC had an intraocular pressure of more than 18 mmHg (p = 0.08). In the MMC group, three eyes required repeated glaucoma surgery (7.7 %; one trabeculectomy, one Baerveldt drainage implant, one cyclodiode laser treatment), while this was two eyes in the TAC group (8.0 %; one Baerveldt drainage implant, one cyclodiode laser treatment) (p = 0.97). The present study demonstrates that in primary trabeculectomy, the 5-year risk profiles of MMC and purified TAC are comparable, suggesting that as an antifibrotic agent TAC is at least as effective as MMC. Prospective randomized trials will need to confirm the agents' relative long-term benefits.

Cyclodiode laser in the treatment of acute angle closure

To describe the outcome of using diode laser transscleral cyclophotocoagulation (cyclodiode laser) as a safe technique in managing acute angle closure refractory to conventional treatment. This is a retrospective case series from two ophthalmic units in the United Kingdom. Five patients with acute angle closure refractory to medical and laser treatment underwent cyclodiode laser treatment. Demographic information, symptoms, medical and surgical treatment, visual outcomes, and intraocular pressure (IOP) control were recorded. All five patients had symptomatic acute angle closure. Conventional management, including topical and systemic medical treatment, laser iridotomy and laser iridoplasty, did not achieve adequate IOP control or relieve symptoms. Emergency cyclodiode laser treatment was performed within 2-23 days of presentation. All patients subsequently required lensectomy at a later date. At final follow-up (6-14 months), all patients had visual acuity of 6/12 or better with well-controlled IOPs (≤ 17 mm Hg). Only one patient was on topical treatment. One patient developed a persistent low-grade anterior uveitis. Cyclodiode laser is a safe alternative to emergency lensectomy or trabeculectomy in cases of acute angle closure, which do not respond to treatment.

The UK National Cyclodiode Laser Survey

To evaluate current practice of transscleral diode laser cyclophotocoagulation (cyclodiode) laser treatment among consultant ophthalmologists in the United Kingdom. A 31-question survey was emailed to all practising consultant ophthalmologists who were members of the Royal College of Ophthalmologists. All non-responders were sent a postal version of the questionnaire. This paper looked at cyclodiode practice patterns and consisted of questions on demographic data, transillumination, and power settings, factors influencing practice, post-operative care, and repeat treatment. A total of 510 participants (53.6%) responded. A total of 180 (35.3%) responders reported performing cyclodiode laser treatment, of which 84 (46.7%) were glaucoma subspecialists (GSS). Initial median power settings used were 1500 mW and 2000 ms. The average number of applications delivered per sitting was 25.5 ± 1.2 applications for GSS vs 20.6 ± 2.0 for non-GSS in a seeing eye (P = 0.0013). In all, 65% routinely transilluminated the globe of which 78% were GSS and 52.3% were non-GSS (P = 0.0009). In all, 43% of the GSS vs 17% of the non-GSS lowered power settings in uveitic glaucoma (P = 0.013). In blind eyes, 30% of the GSS vs 12% of the non-GSS increased energy levels (P = 0.0014). In all, 60% of the responders performed cyclodiode at any visual acuity, whereas 22% performed combined cyclodiode and cataract surgery. This survey highlights a wide variation in the use of cyclodiode laser treatment amongst GSS and non-GSS. However, the most frequently used practice may not be the optimal practice. A more individualised parameter according to the condition of the eyes may optimise the outcome.

Glaucoma considerations in OOKP

Abstract Purpose To study the incidence and prognosis of glaucoma in OOKP eyes and to evaluate methods for detection and treatment of glaucoma following osteo‐odonto‐keratoprosthesis surgery. Methods Retrospective analysis of 49 consecutive patients treated at the national OOKP referral centre in Brighton, UK between November 1996 and September 2009. Data were collected over a 3 month period from December 2009 giving a minimum of 6 months follow up (range: 6 months to 13 years). Data collected include: age at surgery, primary diagnosis, previous surgical procedures (corneal grafts), family history of glaucoma, serial post‐operative cup‐disc ratios and visual fields, glaucoma procedures at any stage, and any OOKP complications. Results A total of 49 patients were included in the study with age ranging from 19 to 88 years (mean 53.5). 14 (28.5%) patients had pre‐existing glaucoma, 25(51%) patients had glaucoma by the end of the study. 12(24.5%) patients developed de novo increase in intraocular pressure. Of the 49 patients, 5 underwent cyclodialysis ,4 had cyclodiode laser treatment, 4 underwent ECP, 5 had a glaucoma tube inserted and 4 had detachment and reattachment of their recti muscles (VRDR ± MRDR). All patients were treated with oral acetozolamide 250mg once daily (except one who is allergic). Sublingual timolol was used in three patients, one of experienced severe side effects and the treatment had to be stopped. Systemic betablockers were used in 3 patients. Conclusion Glaucoma is one of the major complications of osteo‐odonto‐keratoprosthesis. It is difficult to monitor and treat in the OOKP eye. Various treatment modalities have been used. Many patients require long term oral medications and many are not adequately controlled and should have surgical treatment the results of which are not satisfactory. VRDR might represent a safer surgical method to control glaucoma in OOKP eyes.

Scleral perforation after trans‐scleral cyclodiode laser for intraocular pressure reduction

Herein a case is reported of a full-thickness scleral burn in the left eye of a 61-year-old man, following contact trans-scleral cyclodiode laser treatment for traumatic aphakic glaucoma, unresponsive to maximal medical treatment. The defect was successfully repaired by scleral suturing under local anaesthetic.

Malignant glaucoma after phacoemulsification: Treatment with diode laser cyclophotocoagulation

Phacoemulsification was performed in an 84-year-old woman with ocular hypertension and narrow drainage angles, previously treated by neodymium:YAG (Nd:YAG) laser peripheral iridotomy. Despite temporal zonular weakness, the surgery was uneventful. An intraocular lens (IOL) was placed and centered in the capsular bag. Two months later, the patient presented with malignant glaucoma. The IOL optic was anteriorly displaced in the capsular bag, and the IOL shift correlated with a -4.0 diopter myopic refractive error. There was no response after medical treatment or Nd:YAG hyaloidotomy. One week later, a single treatment with transscleral diode laser cyclophotocoagulation was performed. The intraocular pressure normalized and the anterior chamber deepened within 48 hours. The patient's condition has remained stable for 3 months with no further treatment; the Snellen visual acuity is 6/9. If medical therapy fails to control malignant glaucoma, cyclodiode laser treatment may be more effective and have fewer risks than current laser and surgical interventions.