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C.V. Guzman, M.B. Shields, R.A. Adelman; Cyclophotocoagulation Versus Panretinal Photocoagulation in the Management of Neovascular Glaucoma . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5537.
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Purpose: To study and compare the efficacy and safety of laser cyclophotocoagulation (CPC) and panretinal photocoagulation (PRP) in eyes with neovascular glaucoma. Methods: Retrospective study of all patients who underwent either CPC or PRP for the treatment of neovascular glaucoma at the Yale University Eye Center from January 1993 to May 2003. Results: Of the 36 patients in this study, 21 were treated with CPC and 15 with PRP. There was no statistical difference in the age, underlying medical conditions, IOP, severity of neovascularization or the number of medications used at baseline. The mean follow–up time was 12.8 months. The initial IOPs for the CPC and PRP groups were 45.9 and 32.4 respectively. Six months following initial treatment, 33.33% of CPC patients and 50% of PRP patients had an IOP of ≥6 and ≤ 21 (p = 0.231). IOP control in the same range was achieved in 18.18% of CPC patients and 44.44% of PRP patients 1 year following treatment (p = 0.178). Hypotony was significantly more common in the CPC group than the PRP group at the 6–month and 1–year follow–ups (p < 0.01). Of the 21 patients who underwent CPC, 6 lost light perception following treatment whereas only 1 of the 15 patients receiving PRP lost light perception (p<0.05). The initial visual acuities were hand motion for the CPC group and count fingers for the PRP group. At the 1–year follow–up, the mean visual acuities were hand motion and 20/200 for CPC and PRP respectively. The number of glaucoma medications needed was not statistically significant between the two groups until the 2–year follow–up when the PRP group needed significantly more medications than the CPC group (1.8 and 0.22 respectively, p=0.01). The neovascularization of the angle and iris regressed significantly in the PRP group compared to the CPC group starting at the 1–month follow–up and persisting for the duration of the study (p<0.005). Conclusions: In our study, PRP has a lower risk of hypotony and a higher chance of decreasing neovascularization of the iris and angle compared to CPC. This study indicates that, when possible, PRP should be performed before glaucoma surgical intervention.
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