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

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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 22 mmHg. 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 (2000 mW, time: 2.0 s/shot). There was a 55.5 % reduction (total of 14.0 mmHg) of the mean pre-operative IOP (31.5 mmHg) after the first diode laser application (p = 0.0020). Re-treatment was required in 31.2 % of eyes over a mean period of 10.7 months. In these five eyes, the mean pre-operative IOP was 40.4 mmHg, which decreased to 15.0 mmHg post-therapy, and a mean IOP reduction of 25.4 mmHg (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 ≥ 22 mmHg 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.

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Authors and Affiliations

  1. Cornea & External Disease Service, Instituto de Oftalmología y Ciencias Visuales, Escuela Nacional de Medicina, Tecnológico de Monterrey, Monterrey, Mexico

    Alejandro Rodríguez-García, Luis Alonso González-González & J. Carlos Alvarez-Guzmán

  2. Instituto de Oftalmología y Ciencias Visuales, Centro Médico Zambrano-Hellion (1er Piso Ote.), Av. Batallón de San Patricio No. 112, Col. Real de San Agustín, CP 66278, San Pedro Garza García, NL, Mexico

    Alejandro Rodríguez-García

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  1. Alejandro Rodríguez-García
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  2. Luis Alonso González-González
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  3. J. Carlos Alvarez-Guzmán
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Correspondence to Alejandro Rodríguez-García.

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Conflict of interest

The authors have no propriety or financial interest in any of the laser devices or materials used for this study.

Informed consent

All patients included in the study read and signed an informed consent for laser treatment previously approved by the Ethics and Research Committees of our institution in compliance with the ethical principles of the Declaration of Helsinki.

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Rodríguez-García, A., González-González, L.A. & Carlos Alvarez-Guzmán, J. Trans-scleral diode laser cyclophotocoagulation for refractory glaucoma after high-risk penetrating keratoplasty. Int Ophthalmol 36, 373–383 (2016). https://doi.org/10.1007/s10792-015-0130-2

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  • DOI: https://doi.org/10.1007/s10792-015-0130-2

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