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Transscleral diode laser cyclophotocoagulation as primary and secondary surgical treatment in primary open-angle and pseudoexfoliatve glaucoma

Long-term clinical outcomes

  • Clinical Investigation
  • Published:
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Abstract

Background

Transscleral diode laser cyclophotocoagulation (TDLC) has been used successfully in the treatment of refractive glaucoma. However, little is known about TDLC as a primary or secondary surgical procedure in primary open-angle and pseudoexfoliative glaucoma.

Methods

In a retrospective chart review we analyzed 90 eyes (48 OD/42 OS) in 90 patients (mean age 75 years, range 60–92 years; 51 men/39 woman) with primary open-angle glaucoma (n=66) and pseudoexfoliative glaucoma (n=24) who consecutively underwent TDLC with a minimum follow-up of 24 months. In 24 eyes (26.7%) TDLC was the primary surgical treatment. Mean energy was 80 J (60–92 J). Success was defined as a final intraocular pressure (IOP) between 4 and 18 mmHg, a minimum IOP reduction of 20% and the absence of major complications.

Results

The overall success rate was 36.7% after 24 months. A mean of 1.3 procedures was performed per patient. No correlation between age and success rate (p=0.887) or gender and success rate (p=0.895) was seen. There was no significant reduction in antiglaucomatous medication (p=0.208), no significant loss of visual acuity (p=0.324) nor a significant relationship between loss of visual acuity and failure of treatment (p=0.201). In patients with primary open-angle glaucoma the success rate was 40.9% after 24 months; in patients with pseudoexfoliative glaucoma it was 25.0% after 24 months. There was no significant difference between primary open-angle glaucoma and pseudoexfoliative glaucoma (p=0.684). Previous ocular surgery decreased the success probability from 45.8 to 33.3% (p=0.001). Prolonged hypotonia occurred in 1 patient. No phthisis bulbi developed.

Conclusions

Transscleral diode laser cyclophotocoagulation is an effective and safe method not only in the treatment of refractive glaucoma, but also as a primary surgical procedure in primary open-angle and pseudoexfoliative glaucoma. TDLC may be used more widely in glaucoma therapy, although further long-term studies have to confirm these findings.

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Authors and Affiliations

  1. University of Tübingen, Department of Ophthalmology, Schleichstrasse 12, 72076, Tübingen, Germany

    Matthias Grueb, Jens Martin Rohrbach & Karl Ulrich Bartz-Schmidt

  2. Department of Ophthalmology, Clinic Pallas, Louis-Giroud-Strasse 20, 4600, Olten, Switzerland

    Torsten Schlote

Authors
  1. Matthias Grueb
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  2. Jens Martin Rohrbach
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  3. Karl Ulrich Bartz-Schmidt
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  4. Torsten Schlote
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Correspondence to Matthias Grueb.

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The authors have no proprietary interest in any of the products used in the study.

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Grueb, M., Rohrbach, J.M., Bartz-Schmidt, K.U. et al. Transscleral diode laser cyclophotocoagulation as primary and secondary surgical treatment in primary open-angle and pseudoexfoliatve glaucoma. Graefe's Arch Clin Exp Ophthalmo 244, 1293–1299 (2006). https://doi.org/10.1007/s00417-006-0280-z

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  • DOI: https://doi.org/10.1007/s00417-006-0280-z

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