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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
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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.


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.


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.


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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  1. Becker M, Funk J (2001) Diodenlaser-Zyklophotokoagulation als primarer chirurgischer Eingriff bei Glaukom. Ophthalmologe 98:1145–1148

    Article  PubMed  CAS  Google Scholar 

  2. Bloom PA, Tsai JC, Sharma K, Miller MH, Rice NS, Hitchings RA, Khaw PT (1997) ‘‘Cyclodiode’’. Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma. Ophthalmology 104:1508–1519; discussion 1519–1520

    PubMed  CAS  Google Scholar 

  3. Brancato R, Carassa RG, Bettin P, Fiori M, Trabucchi G (1995) Contact transscleral cyclophotocoagulation with diode laser in refractory glaucoma. Eur J Ophthalmol 5:32–39

    PubMed  CAS  Google Scholar 

  4. Broadway DC, Chang LP (2001) Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma 10:237–249

    Article  PubMed  CAS  Google Scholar 

  5. Egbert PR, Fiadoyor S, Budenz DL, Dadzie P, Byrd S (2001) Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for primary open angle glaucoma. Arch Ophthalmol 119:345–350

    PubMed  CAS  Google Scholar 

  6. Fankhauser F, Kwasniewska S, Van der Zypen E (2004) Cyclodestructive procedures. I. Clinical and morphological aspects: a review. Ophthalmologica 218:77–95

    Article  PubMed  Google Scholar 

  7. Feldman RM, El-Harazi SM, LoRusso FJ, McCash C, Lloyd WC III, Warner PA (1997) Histopathologic findings following contact transscleral semiconductor diode laser cyclophotocoagulation in a human eye. J Glaucoma 6:139–140

    PubMed  CAS  Google Scholar 

  8. 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; discussion 243–246

    PubMed  CAS  Google Scholar 

  9. Gupta N, Weinreb RN (1997) Diode laser transscleral cyclophotocoagulation. J Glaucoma 6:426–429

    Article  PubMed  CAS  Google Scholar 

  10. Higginbotham EJ (1999) Reaffirming the role of the laser in glaucoma management. Arch Ophthalmol 117:1075–1076

    PubMed  CAS  Google Scholar 

  11. Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE, Collaborative Initial Glaucoma Treatment Study Group (2005) Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 140:16–22

    Article  PubMed  Google Scholar 

  12. Kosoko O, Gaasterland DE, Pollack IP, Enger CL (1996) Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophthalmology 103:1294–1302

    PubMed  CAS  Google Scholar 

  13. Kramp K, Vick HP, Guthoff R (2002) Transscleral diode laser contact cyclophotocoagulation in the treatment of different glaucomas, also as primary surgery. Graefes Arch Clin Exp Ophthalmol 240:698–703

    Article  PubMed  Google Scholar 

  14. Mietz H, Raschka B, Krieglstein GK (1999) Risk factors for failure of trabeculectomies performed with antimetabolites. Br J Ophthalmol 83:814–821

    PubMed  CAS  Google Scholar 

  15. Schlote T, Kreutzer B, Kriegerowski M, Knorr M, Thiel HJ (1997) Diodenlaser-Zyklophotokoagulation in der Behandlung therapierefraktarer Glaukome. Klin Monatsbl Augenheilkd 211:250–256

    PubMed  CAS  Google Scholar 

  16. Schlote T, Derse M, Rassmann K, Nicaeus T, Dietz K, Thiel HJ (2001) Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma. J Glaucoma 10:294–301

    Article  PubMed  CAS  Google Scholar 

  17. Spencer AF, Vernon SA (1999) “Cyclodiode”: results of a standard protocol. Br J Ophthalmol 83:311–316

    Article  PubMed  CAS  Google Scholar 

  18. Threlkeld AB, Johnson MH (1999) Contact transscleral diode cyclophotocoagulation for refractory glaucoma. J Glaucoma 8:3–7

    CAS  Google Scholar 

  19. Werner A, Vick HP, Guthoff R (1998) Zyklophotokoagulation mit dem Diodenlaser. Ophthalmologe 95:176–180

    Article  PubMed  CAS  Google Scholar 

  20. Wong EY, Chew PT, Chee CK, Wong JS (1997) Diode laser contact transscleral cyclophotocoagulation for refractory glaucoma in Asian patients. Am J Ophthalmol 124:797–804

    PubMed  CAS  Google Scholar 

  21. Yap-Veloso MI, Simmons RB, Echelman DA, Gonzales TK, Veira WJ, Simmons RJ (1998) Intraocular pressure control after contact transscleral diode cyclophotocoagulation in eyes with intractable glaucoma. J Glaucoma 7:319–328

    Article  PubMed  CAS  Google Scholar 

  22. Youn J, Cox TA, Herndon LW, Allingham RR, Shields MB (1998) A clinical comparison of transscleral cyclophotocoagulation with neodymium: YAG and semiconductor diode lasers. Am J Ophthalmol 126:640–647

    Article  PubMed  CAS  Google Scholar 

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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).

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