Transscleral diode laser contact cyclophotocoagulation in the treatment of different glaucomas, also as primary surgery

Abstract

Purpose. To evaluate the clinical outcome of transscleral cyclophotocoagulation (TSCPC) with the diode laser for different glaucomas, especially as primary surgery.

Methods. A retrospective analysis of 250 TSCPC (193 eyes of 145 patients) with different glaucomas and an average age of 62.6±17.1 years. Postoperative follow-up ranged from 6 to 48 months (mean 13.9 months). Most of the patients had primary open-angle glaucoma (POAG) or secondary glaucoma. All eyes were treated with 24–30 spots and 1.4–1.8 W at an exposure time of 2 s using a diode laser with a focussing tip.

Results. The mean intraocular pressure (IOP) decreased from 24.6±6.7 mmHg before to 19.3±5.7 mmHg after operation (P<0.001). The IOP was successfully controlled (final IOP 10–22 mmHg) in 76.4% of cases after a single or multiple TSCPC treatments. The reductions in maximal IOP and in the number and frequency of administration of antiglaucomatous drugs were also significant (P<0.001). The best results were obtained among the patients with POAG, in the oldest age group and in those patients without any previous or subsequent glaucoma operations. The proportion of eyes requiring multiple treatments was 21.2%, with an average of 1.3 treatments per eye. There was a complication rate of 14.4%, mostly mild uveitis. Phthisis bulbi occurred in three eyes (1.6%).

Conclusions. TSCPC with the diode laser is a safe, effective procedure to reduce the IOP in the treatment of different glaucomas with few severe complications. It is also suitable for primary surgical treatment.