Zusammenfassung
Zur Behandlung eines therapieresistenten Glaukoms wurde bei 64 Augen von 62 Patienten eine transsklerale Zyklophotokoagulation mit einem Diodenlaser (Wellenlänge 810 nm; IRIS Medical OcuLight SLx) durchgeführt.
Der intraokulare Druck war bei 73% der Patienten durch eine Operation und gegebenenfalls Umstellung der antiglaukomatösen Therapie gut reguliert. Im Beobachtungszeitraum von 3 bis 15 Monaten erfolgte bei 8 Augen eine Reoperation, bei 5 Augen war eine zweite Reoperation erforderlich, um Druckregulierung bzw. Schmerzfreiheit zu erzielen.
Die postoperativen Komplikationen wie iritischer Reizzustand, Vorderkammerblutung, Aderhautabhebung oder zystoides Makulaödem konnten konservativ gut beherrscht werden, eine Phtisis bulbi trat bisher nicht auf. Neben der im Vergleich zur Kryokoagulation recht hohen Erfolgs- und der relativ geringen Komplikationsrate spricht auch die mögliche Wiederholbarkeit der Operation für den weiteren Einsatz dieses zyklodestruktiven Verfahrens.
Summary
Sixty-four eyes of sixty-two patients with refractory glaucoma of different etiology were treated with transscleral cyclophotocoagulation using a diode laser (wavelength 810 nm; IRIS Medical OcuLight SLx). Within the follow-up period from 3 to 15 months 73% of the cases were regulated by one operation and sometimes a change of topical therapy. Only 8 eyes required one and 5 eyes required two retreatments to achieve a sufficient regulation and/or loss of pain.
The complications were mild iritis, hyphema, choroidal effusion or cystoid macula edema. They could be easily managed with conservative treatment, no phtisis bulbi was observed.
Compared to cyclocryotherapy this methods seems to offer a higher success rate with relatively few complications, a short surgery time and the possibility of several retreatments. This cyclodestructive procedure is a valuable addition in the management of therapy-resistant glaucoma.
Similar content being viewed by others
Literatur
Assia EI, Hennis HL, Stewart WC, Legier UFC, Carlson AN, Apple DJ (1991) A comparison of neodym: YAG and diose laser transscleral cyclophotocoagulation and cyclocryotherapy. Invest Ophthalmol Vis Sci 32: 2774–2778
Benning H, Pfeiffer N (1995) Therapeutic range in transscleral contact cyclophotocoagulation. German J Ophthalmol 4: 11–15
Bloom PA, Sharma K, Tsai J, Miller MH, Khaw PT, Rice NS, Hitchings RA (1995) Control of intraocular pressure by transscleral diode laser ablation of the ciliary body in advanced refractory glaucoma. Invest Ophthalmol Vis Sci 36: 3857
Brancato R, Leoni G, Trabucchi G, Cappellini A (1991) Histopathology of continuous wave neodym: YAG and diode laser contact transscleral lesions in rabbit ciliary body. Invest Ophthalmol Vis Sci 32: 1586–1592
Carassa RG, Brancato R, Bettin P, Fiori M, Durante A (1996) Contact transscleral cyclophotocoagulation with diode laser: a long-term follow-up study. Invest Ophthalmol Vis Sci 37 (3): 1193
Dickens CJ, Nguyen N, Mora JS, Iwach AG, Gaffney MM, Wong PC, Tran H (1995) Long-term results of noncontact transscleral neodym: YAG cyclophotocoagulation. Ophthalmology 102: 1777–1781
Klein S, Rockwood EJ, Baerveldt G (1996) Diode laser versus contact transscleral Nd: YAG cyclophotocoagulation for uncontrolled glaucoma. Invest Ophthalmol 37 (3): 1192
Gaasterland DE, Pollack IP (1992) Initial experience with a new method of laser transscleral cyclophotocoagulation for ciliary ablation in severe glaucoma. Trans Am Ophthalmol Soc 90: 225–243
Hawkins TA, Stewart WC (1993) One-year results of semiconductor transscleral cyclophotocoagulation in patients with glaucoma. Arch Ophthalmol 111: 448–491
Hennis HL, Stewart WC (1992) Semiconductor diode laser transscleral cyclophotocoagulation in patients with glaucoma. Am J Ophthalmol 113: 81–85
Herndon LW, Trevisani MG, Imami N, Straub D, Allingham RR, Shields MB (1996) Laser scatter reaching the posterior pole during laser cyclophotocoagulation (1996) Invest Ophthalmol 37 (3): 1139
Immonen IJR, Puska P, Raitta C(1994) Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma. Ophthalmology 101: 876–882
Schubert HD (1989) Cyclophotocoagulation: How far posterior to the limbus is the ciliary body? Ophthalmology 96: 139–140
Schuman JS, Belows AR, Bradford JS, Latina MA, Allingham RR, Belcher CD, Puliafito CA (1992) Contact transscleral Nd: YAG laser cyclophotocoagulation. Ophthalmology 99: 1089–1095
Stolzenburg S, Müller-Stolzenburg N, Kresse S, Müller GJ (1992) Kontaktzyklophotokoagulation mit dem Dauerstich-Nd: YAG-Laser über Quarzfaser. Ophthalmologe 89: 210–217
Suzuki Y, Araie M, Yumita Y, Yamamoto T (1991) Transscleral Nd: YAG laser cyclophotocoagulation versus cyclocryotherapy. Graefe’s Arch Clin Exp Ophthalmol 229: 33–36
Ulbig MW, McHugh D, McNaught A, Hamilton P (1994) Contact diode laser cyclophotocoagulation for refractory glaucoma. German J Ophthalmol 3: 212–215
Verdi M, Carassa RG, Bettin P, Fiori M, Brancato R (1995) Does diode laser contact transscleral cyclophotocoagulation produce scleral thinning? An ultrasound biomicroscopal in vivo study of human eyes. Invest Ophthalmol Vis Sci 36: 2628
Weekers R, Lavergne G, Watillon M, Gilson M, Legros AM (1961) Effects of photocoagulation of ciliary body upon ocular tension. Am J Ophthalmol 52: 423–436
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mistlberger, A., Tschiderer, H., Ruckhofer, J. et al. Transsklerale Zyklophotokoagulation mit dem Diodenlaser zur Behandlung therapieresistenter Glaukome. Spektrum Augeheilkd 11, 45–48 (1997). https://doi.org/10.1007/BF03164097
Issue Date:
DOI: https://doi.org/10.1007/BF03164097