Diode Cyclophotocoagulation Research Articles

Evaluation of ciliary body by ultrasound bio-microscopy after trans-scleral diode cyclo-photocoagulation in refractory glaucoma.

To evaluate the morphological changes of the ciliary body after diode laser trans-scleral cyclo-photocoagulation using ultrasound bio-microscopy in refractory glaucoma. This prospective, interventional, non-comparative, non-randomized, longitudinal study was performed on 40 eyes with refractory glaucoma, during the period between February 2016 and March 2018. All patients were treated with single session diode laser trans-scleral cyclo-photocoagulation. The intraocular pressure was obtained over a period of 3 months after the operation and morphological changes of the ciliary body were observed using ultrasound bio-microscopy. Trans-scleral cyclo-photocoagulation has achieved a reasonable success in reducing intraocular pressure to less than 22 mm Hg without increasing the number of glaucoma medication. The overall success rate was 40%, as the intraocular pressure decreased from a baseline mean value of 54.70 ± 12.27 to 42.45 ± 9.85 mm Hg 1 week after operation, 33.50 ± 8.00 mm Hg after 1 month, and 25.60 ± 6.62 after 3 months of operation. Ultrasound bio-microscopy detected reduction in the length and width of ciliary processes in addition to the ciliary muscle thickness of the treated quadrants. Intraocular pressure was more correlated to the width of the ciliary processes. Trans-scleral cyclo-photocoagulation is a rapid and effective procedure in treatment of refractory glaucoma with intraocular pressure reduction. Ultrasound bio-microscopy is a promising twin tool for cyclo-destructive procedures to detect ciliary body changes and can be used as a guide for re-treatment procedures.

Micropulse diode cyclophotocoagulation: A review of the literature

Transscleral diode cyclophotocoagulation (CPC) has conventionally been reserved for refractory glaucoma, where other surgery is not feasible. The newer micropulse cyclophotocoagulation (mpCPC) has become popular in recent times and is increasingly being used as a primary surgery for glaucoma in eyes with good vision. The available literature on mpCPC and its mechanism, histological changes caused in the eye, the technique of usage, efficacy, safety, potential applications, and comparison with continuous wave CPC and other surgeries have been reviewed. Varying criteria for inclusion and different definitions of success in studies make a direct comparison between studies difficult. The lack of definite evidence to prove superiority of mpCPC and the potential for rare but reported sight threatening complications should be kept in mind, especially before using this in nonrefractory cases of glaucoma when other time tested options are available.

Micropulse diode treatment in refractory neovascular glaucoma, high-energy level combined with adjunctive Ranibizumab

Introduction: Neovascular glaucoma is one of the highly refractory glaucoma types that mandates frequent modification of treatment. Micropulse diode cyclophotocoagulation may be a good option, but it may need an adjunctive and modification of parameters away from standard protocol. Design: A prospective, cohort, interventional case study. Purpose: To assess the safety and efficacy of high energy level of micropulse (MP) diode laser application after intravitreal injection of ranibizumab in the treatment of neovascular glaucoma refractory to medical treatment. Patients and Methods: This is a prospective, interventional, cohort, randomized case series study that included patients with neovascular glaucoma refractory to medical treatment. All patients underwent intravitreal injection of ranibizumab and then MP diode transscleral cyclophotocoagulation treatment in a high energy level. All patients were followed up for 24 months. The primary outcome measure was IOP reduction; the secondary outcome measure was stability and number of retreatment sessions; and the third outcome measure was complications. Results: This study included 50 eyes of 50 patients, 52% of them were male while 48% were female. Age of the studied patients ranged between 42 and 74 years with a mean of 60.8 ± 7.6 years. Cause of neovascular glaucoma was diabetes in 31 (62%), RVO in 8 (16%), and ocular ischemic syndrome in 3 (6%) of cases. The mean preoperative IOP was 41.2 ± 5.8 mmHg that decreased to 17.62 ± 2.01, 19 ± 4.05, 18.16 ± 1.96, 18.38 ± 1.96, 18.12 ± 1.98, and 18.3 ± 2.18 mmHg at 1, 3, 6, 12, 18, and 24 months, respectively (P

Современный взгляд на циклодеструктивные операции при глаукоме

The main purpose of glaucoma treatment is to reduce the intraocular pressure (IOP) to a target level. One of the pathogenetically justified method of treatment for various types of glaucoma, first of all its refractory forms, is the surgery on the ciliary body. A purpose of such manipulations is to suppress excessive formation of aqueous humor. Previously, diode laser cyclophotocoagulation was widely used, which is mainly applied in terminal glaucoma. Technological innovations have led to the development of perspective, more safe, and less destructive methods of cyclodestructive anti-glaucomatous operations, such as micro-pulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation, and ultrasound cyclodestruction. During micro-pulse cyclophotocoagulation, the effect of laser energy occurs by short pulses at rest intervals, which significantly reduces the absorption of energy by surrounding tissues and their associated damage. With endoscopic cyclophotocoagulation, the epithelium of the ciliary processes is directly coagulated, which makes it possible to dose laser energy under visual control. Ultrasonic cyclodestruction causes a coagulation necrosis of the ciliary processes with a very insignificant collateral damage of surrounding tissues. Today these surgical techniques are becoming more relevant in the treatment of refractory glaucoma in order to preserve visual functions. This review is an analysis of modern literature, reflecting the efficacy and safety of cyclodestructive operations with sufficiently high visual functions.

Prospective evaluation of micropulse transscleral diode cyclophotocoagulation in refractory glaucoma: 1 year results.

To evaluate the effectiveness in in-traocular pressure reduction and safety of micropulse trans-scleral diode cyclophotocoagulation in refractory glaucoma. We prospectively evaluated a case series of 21 eyes of 21 consecutive patients with refractory glaucoma treated with micropulse transscleral diode cyclophotocoagulation at 12-month follow-up. The total treatment time was at the discretion of the surgeon, considering baseline and target intraocular pressure and glaucoma diagnosis. Intraocular pressure, inflammation, visual acuity, and number of medications were monitored. Success was defined as intraocular pressure between 6 and 21 mmHg and/or 30% reduction from baseline intraocular pressure with or without the use of antiglaucoma medications. Visual acuity loss was defined as a loss of ≥2 lines of vision on the Snellen chart or a ≥2-level decrease in visual function in patients with nonmeasurable chart acuity. The mean age was 61.04 ± 12.99 years, and 11 (52.4%) patients were male, with most (95%) patients showing low visual acuity at baseline (count fingers or worse). The mean intraocular pressure was 33.38 ± 15.95 mmHg, and the mean number of medications was 3.5 ± 1.1 at baseline. After 1, 3, 6, and 12 months, 76.19%, 57.14%, 55.56%, and 66.67%, respectively, of the patients were classified as treatment successes. Seven (33.3%) patients required new laser treatment and were considered treatment failures. The mean intraocular pressure reduction was 44.72% ± 29.72% in the first week and 41.59% ± 18.93% at the end of follow-up (p=0.006). The mean number of medications significantly dropped to 2.00 ± 1.7 at the 12-month visit (p=0.044). Complications included hypotony (4.8%), intraocular inflammation after 1 month (19%), and visual acuity loss (4.8%). Micropulse transscleral diode cyclophotocoagulation was safe and effective for reducing intraocular pressure in eyes with refractory and advanced glaucoma, with reduced need for ocular antihypertensive medication.

Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options.

The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.

An Overview of Treatment Methods for Primary Angle Closure

ABSTRACTBackground: Glaucoma is the second leading cause of blindness in the world. Angle closure glaucoma accounts for 25% of all glaucoma, with Asia having the highest rate. Angle closure is an anatomical variation, making the Inuit, Chinese, and other Asians more susceptible. Current treatments include medical, laser, and surgical modalities.Purpose: To identify the current treatment protocols for primary angle closure. Discussion: The current general protocol to treat angle closure is to lower the intraocular pressure with medications and perform laser iridotomy. However, cataract surgery, laser iridoplasty, goniosynechiolysis, diode cyclophotocoagulation, and filtering surgery are additional treatment modalities used for primary angle closure. Conclusion: Primary angle closure occurs due to various anatomical angle variations. Laser iridotomy is not the sole method of treatment. Specifically, cataract surgery can be particularly effective in the treatment and prevention of angle closure. Recalcitrant cases can be treated with trabeculectomy and shunt implants, although these are not usually first-line treatments.

Intraocular Pressure Outcomes Following Transscleral Diode Cyclophotocoagulation Using Long and Short Duration Burns.

The purpose of this study was to compare outcomes of transscleral diode cyclophotocoagulation using short duration (SD) versus longer duration (LD) treatment. Data were collected retrospectively on patients with glaucoma who underwent cyclophotocoagulation with LD (4000 ms) treatment with variable power ≤1000 mW versus SD using 1500 ms with variable power ≤2000 mW. The outcome measures included: intraocular pressure (IOP) at 12 months, decrease in number of antiglaucoma medications, complications and visual acuity (VA) at the final follow-up visit. There were 71 patients and 70 patients in the SD and LD groups, respectively. The mean IOP±SD pretreatment baseline was 33±10 versus 36±10 mm Hg for SD and LD groups, respectively (P>0.05). At 1 year postoperatively, the IOP decreased significantly in both groups (16.7 vs. 17.4 mm Hg for SD and LD, respectively; P<0.0001). This decrease in IOP was comparable between groups (P=0.5). The average number of IOP lowering medications were 2.5 and 2.9 at baseline in the SD and LD groups, respectively, and decreased to 1.3 in both groups (P=0.83). The mean LogMAR VA decreased significantly from 1.87 at baseline to 1.96 at 1 year in the SD group (P=0.276), and 2.03 to 2.3 (P≤0.001) in the LD group, this change was comparable (0.19; P=0.075) between the 2 groups. Complications were also comparable. Both LD and SD burns during cyclophotocoagulation effectively lowered IOP at 1 year. Neither treatment resulted in a greater reduction of IOP. LD treatment appeared to result in a decrease in VA and greater postoperative inflammation.

Rates of glaucomatous visual field change before and after transscleral cyclophotocoagulation: a retrospective case series.

BackgroundThe primary goal of glaucoma treatment is to lower and control intraocular pressure (IOP) and thereby prevent functional deterioration. For glaucomas that are refractory to medical and incisional surgical therapies, transscleral diode cyclophotocoagulation (TCP) is a well-established procedure to effectively decrease IOP. This study investigated rates of visual field (VF) change in patients with glaucoma before and after TCP.MethodsThis retrospective case series investigated rates of VF changes in glaucoma patients before and after they underwent TCP. At least four VF examinations were required, two before and two after surgery. VF examinations were performed using standard automated perimetry and rates of change were calculated by linear regression analysis of mean deviation (MD) values measured over time.ResultsA total of 46 eyes of 43 patients were included and followed on average 3.6 years before and 2.1 years after TCP. 67 % of the eyes showed further progression of glaucoma following surgery. Mean preoperative MD change was −0.21 dB/year (SE = 0.08, 95 % CI [−0.06, −0.37]). Postoperatively the mean change was −0.26 dB/year (SE = 0.22 95 % CI [0.38, −0.48]) which results in a difference between pre- and postoperative MD rate of 0.05 dB/year (p = 0.824). The mean MD value was worse after surgery and dropped by 1.73 dB (SE = 0.58, 95 % CI [−0.59, −2.87], p = 0.003). Intraocular pressure (IOP) decreased from 23.2 mmHg (SD = 4.67) before TCP to 14.3 mmHg (SD = 3.17) after TCP (p < 0.001). For each 1 mmHg of IOP reduction after surgery, postoperative rate of VF loss decreased by 0.15 dB/year.ConclusionRates of glaucomatous visual field loss did not significantly change after TCP and the majority of the eyes showed further progression of glaucoma after surgery. Mean MD value was considerably lower after TCP.

Sympathetic ophthalmia following diode laser cyclophotocoagulation

BackgroundSympathetic ophthalmia is a rare form of bilateral uveitis that develops following an ocular penetrating injury to one eye. Several cases of sympathetic ophthalmia have been reported after non-penetrating cyclodestructive...

A New Technique for Diode Laser Cyclophotocoagulation

Destruction of the ciliary body, an option in glaucoma surgical treatment, can be performed using various methods. Laser energy, now the principle source for cyclodestruction, can be delivered in a transpupillar, transvitreal in conjunction with a vitrectomy and transscleral manner. The current technique for endocyclophotocoagulation requires of an endoscopic probe. We describe an accessible and inexpensive alternative. Gonioprism-assisted diode cyclophotocoagulation (GADC) with a peripheral corneal approach is a new surgical technique for pseudophakic and aphakic patients that uses a manual gonioprism, iris hooks, ophthalmic operating microscope, and an 810-nm laser diode probe. GADC is performed under topical and intracameral anesthesia, prior pupil dilation. First, 4 iris hooks are placed to expose the posterior chamber. The ciliary processes are viewed through a Swan-Jacob gonioprism and the diode laser probe is inserted through a peripheral corneal incision. The energy of the laser is set at 250 mW and the duration of the application to each process is variable, from 500 to 800 ms, until shrinkage and whitening occur. We apply this technique in approximately 360 degrees of the ciliary processes. Subconjunctival dexamethasone phosphate is administered at the end of the surgery prior subconjunctival injection of lidocaine. GADC has a relatively quick learning curve, allows direct visualization with less energy delivered to the ciliary processes and obviates the acquisition of a new endoscopic device.

Update on results and complications of cyclophotocoagulation

This review highlights recently published studies on transscleral and endoscopic diode cyclophotocoagulation (TCP, ECP) and summarizes the treatment results and complications. Although both TCP and ECP are efficacious procedures for the treatment of refractory glaucoma, no consensus exists for optimum treatment protocol. TCP has mainly been used as a last-resort treatment for intractable glaucoma with very limited visual potential. Repeated treatment is often required. Serious complications include vision loss, hypotony, and phthisis. High treatment energy per session and underlying abnormality seem risk factors for these complications. Recent growing numbers of investigations are giving promising results for TCP as a primary surgery in eyes with good vision. Although ECP came later into clinical use for glaucoma treatment, it is becoming more accepted and no longer reserved for end-stage cases. ECP is most commonly performed in conjunction with cataract surgery and shows overall good success with relatively low complication rates. Serious complications include hypotony, phthisis, cystoid macular edema, and retinal detachment. Recent literatures suggest that both TCP and ECP are performed increasingly as the primary surgery for various types and stages of glaucoma. Both treatments are effective procedures, although potential for serious complications exists.

Transscleral diode laser cyclophotocoagulation for refractory glaucoma secondary to juvenile idiopathic arthritis: a short term follow-up

To evaluate the success rates of transscleral diode cyclophotocoagulation (TD-CPC) for refractory secondary glaucoma in a paediatric patient with juvenile idiopathic arthritis. Report of a case of a 6-year-old boy suffering from severe uveitis, and secondary open angle glaucoma. The patient had undergone bilateral cataract surgery, two prior trabeculectomies in the left and one in the right eye. He was under systemic immunomodulation with methotrexate and cyclosporine. He presented with medically uncontrolled glaucoma, with an intraocular pressure (IOP) of 36 and 34mmHg in the right and left eye, respectively, under maximal medical antiglaucoma therapy. TD-CPC was performed under general anesthesia, including a total of 20 spots in the right and 34 in the left eye (2,000mW, 2s/spot) applied in one session. Visual acuity remained stable in the right eye and deteriorated in the left eye from 0.1 to no light perception. Postoperative hypotony was present 1month post op and IOP was 14mmHg in the left and 17mmHg in the right eye, respectively, in the 6-month follow-up with a topical beta-blocker. The anterior chamber was quiet in both eyes. TD-CPC was effective in the short term as IOP lowering therapy in a pediatric patient with refractory uveitic glaucoma.

Risk Factors for Hypotony After Transscleral Diode Cyclophotocoagulation

To evaluate risk factors associated with hypotony after transscleral diode cyclophotocoagulation (TCP) in East Asian patients with intractable glaucoma. Clinical data from 90 eyes of 90 patients who underwent TCP for various indications at Singapore National Eye Centre between 2005 and 2007 were retrospectively reviewed. Baseline intraocular pressure (IOP) was compared with postoperative IOP at 1 month, 3 to 6 months, and 1 year. Mean total energy per session was calculated in Joules and retreatment rates were recorded. Change in visual acuity and number of medications were recorded at 1-year follow-up. Success was defined as percentage of patients achieving an IOP of 5 to 21 mm Hg with or without medications. Hypotony was defined as IOP <5 at the end of 1-year follow-up period. Factors, such as underlying diagnosis, total energy used, age, earlier operations, and retreatment rates, which may influence the development of hypotony were analyzed using univariate analysis. Success was achieved in 54.0% of patients. Mean total energy used was 83.3±31.7 J. Mean pretreatment IOP was 41.8±12.9 mm Hg, which reduced to 20.7±12.1 mm Hg (P<0.001) at 1 month and 17.8±12.9 mm Hg (P<0.001) at 1 year. Sixteen (39.0%) patients developed hypotony. Univariate analysis showed that neovascular glaucoma patients have a significantly increased risk for developing hypotony post TCP (odds ratio=9.17, 95%; confidence interval=1.85-45.36). Underlying diagnosis of neovascular glaucoma is a significant risk factor for hypotony post TCP.

Practice Preferences for Glaucoma Drainage Device Implantation and Cyclodestruction in Australia and New Zealand

To evaluate the practice patterns in the use of glaucoma drainage devices (GDD) and cyclodestruction among consultant ophthalmologists in Australia and New Zealand. A 22-part questionnaire regarding GDD implantation and cyclodestruction practices was sent to all ophthalmologists registered with the Royal Australian and New Zealand College of Ophthalmologists in 2008 by post or e-mail. Sixty-six percent of 872 questionnaires were returned, of these, 14% were from glaucoma subspecialists. Ten percent of all respondents performed GDD implantations. Molteno drains were the most popular device (69%). The most commonly recognized indications for GDD implantation were a history of 2 failed trabeculectomies (85%), neovascular glaucoma (71%), iridocorneal endothelial syndrome (55%), and uveitic glaucoma (52%). Only a minority of surgeons used intraoperative mitomycin C (38%) or 5-fluorouracil (26%) when implanting GDD. Cyclodestruction had been performed by 20% of all respondents. External diode cyclophotocoagulation was the most preferred treatment mode (73%). Sixty-seven percent treated 180 degrees of the ciliary body during initial treatment. Fifty-five percent treated only the earlier untreated area during retreatment. Only 11% of surgeons who performed cyclodestruction agreed that the indications for cyclodestruction are expanding. A wide range of practice patterns for GDD implantation and cyclodestruction exist among Australian and New Zealand ophthalmologists. This likely reflects a paucity of good evidence to guide practice. The Australasian indications for GDD implantation were moderately different from the reported practice in America. Well-designed clinical trials are needed to better define the indications and best practice for these 2 important glaucoma treatment modalities.

Long-term reduction of laser flare values after trabeculectomy but not after cyclodestructive procedures in uveitis patients

The aim of this study was to examine long-term changes of laser flare (LF) after trabeculectomy (TE) and transscleral diode cyclophotocoagulation (TDCPC) in patients with uveitic secondary glaucoma. Retrospective, single-center analysis. Overall, 40 TE (mean follow-up 21.1months) and 68 TDCPC (mean follow-up 21.8months, P=0.38) procedures were performed. The intraocular pressure (IOP) level was consistently lower in the TE group at the preoperative visit and at each follow-up visit, while IOP reduction was similar in both groups (P=0.91). LF decreased from 59.4 photons/ms at baseline to 41.9 photons/ms in the TE group (P=0.017) and remained unchanged in the TDCPC group (71.2 vs. 70.7 photons/ms, P=0.84). No significant increase in the number of complications could be observed at the end of the postoperative follow-up, while best-corrected visual acuity drop and cataract formation was higher in the TE group. TE significantly reduced postoperative LF values. Higher LF values did not increase the development of new complications in this study, but an increased occurrence of cataract formation was seen in the TE group.

Subluxation einer retropupillaren Irisklauenlinse nach Zyklophotokoagulation

A 78-year-old patient underwent diode cyclophotocoagulation for end-stage pseudoexfoliation glaucoma after many surgical interventions on the only functional eye. On the first post-operative day the eye showed a mild flare and the intraocular eye pressure was normal. Nevertheless the patient complained of a severe decrease of visual acuity. A subluxation of a retropupillary iris claw intraocular lens within an atrophic area of the iris was found. During surgical revision the iris claw lens was successfully repositioned in the posterior chamber and an enclavation was performed at a different location avoiding atrophic areas of the iris. Fixation of an iris claw lens onto an atrophic iris structure should be avoided. Subluxation of an iris claw lens can occur following an uncomplicated diode laser cyclophotocoagulation operation.

Cyclophotocoagulation versus sequential tube shunt as a secondary intervention following primary tube shunt failure in pediatric glaucoma

To examine the efficacy of a sequential tube shunt versus transscleral diode cyclophotocoagulation following failure of an initial tube shunt on maximal medical therapy in treatment of refractory childhood glaucoma. A nonrandomized retrospective chart review was conducted of 17 eyes of 14 pediatric patients (less than 18 years old) with refractory glaucoma treated with either sequential tube shunt (Group A) or diode cyclophotocoagulation (Group B) following initial failed tube shunt. Success was defined as an intraocular pressure < or =22 mm Hg on medical therapy, no visually devastating complications, and no further glaucoma surgery performed or recommended. Of the 17 eyes, 8 had a sequential tube shunt and 9 underwent diode cyclophotocoagulation as a secondary procedure. Kaplan-Meier analysis demonstrated a successful outcome of 75% and 62.5% at 12 months and 24 months, respectively, for Group A, and 66.7% at both 12 months and 24 months for Group B (p = 0.48). Corneal decompensation or graft failure was noted in 3/8 eyes (38%) in Group A. Cataract surgery was performed in 2/5 phakic eyes (40%) in Group B. One eye in each group progressed to no light perception. Diode cyclophotocoagulation and sequential tube shunt following primary tube shunt failure in childhood glaucoma showed similar efficacy and complication rates. However, the small sample size of this study warrants further evaluation of these 2 procedures following failure of a tube shunt device in pediatric glaucoma.

Refractory glaucoma – tube or diode?

The aim of the present study was to assess the relative effectiveness of tube surgery and cyclodiode laser in terms of achieving intraocular pressure control. A retrospective study was undertaken to compare patients undergoing double plate Molteno tube implantation with patients undergoing diode cyclophotocoagulation. Intraocular pressure (IOP) was documented at 7 days prior to surgery and postoperatively at various time points. Surgical success was defined as a final IOP between 6 (inclusive) and 21 mmHg (inclusive), without the use of topical medication, while 'qualified' success was defined as IOP within the same range with the use of topical medication. Twenty-eight diode patients and 26 tube patients were included for the study. An average follow up of 150 weeks (range = 21-322 weeks) was available. Mean preoperative IOP was 37 +/- 12 mmHg for the tube group and 39 +/- 16 mmHg for the diode group (t = 0.51, P = 0.61). The final IOP was 17 +/- 12 mmHg for the tube group and 21 +/- 13 mmHg for the diode group (t = 0.35, P = 0.73). Surgical success was achieved in 46% of tube eyes and 11% of diode eyes, while qualified success was achieved in 81% of tube eyes compared with 64% of eyes in the diode group. Two eyes which underwent diode became phthisical. IOP control may be achieved in a greater number of patients with tube surgery. The possible benefits of IOP control in diode patients need to be weighed against the risks of long-term visual loss and the need for multiple re-treatments in this group.

Necrotizing scleritis following diode laser trans-scleral cyclophotocoa- gulation

We report a case of necrotizing scleritis following diode cyclo-photocoagulation (CPC). A-64-year-old-Asian Indian male presented with pseudophakic corneal decompensation with secondary angle closure glaucoma that was uncontrolled with maximum medical therapy. Trans-scleral diode CPC was performed in the inferior 180-degree section using a standard diode laser with a G-probe. One month later, the patient developed features suggestive of necrotizing scleritis that resolved with systemic steroid therapy. Necrotizing scleritis following diode CPC has been rarely reported. Ophthalmologists should be aware of the possible occurrence of surgically induced nectotizing scleritis following diode CPC.