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K.E. Wilhite, B.A. Hughes, M.S. Juzych, M.Y. Alexander, C. Kim; Comparing Efficacy of Cyclophotocoagulation Treatment Between Primary Open Angle Glaucoma and Neovascular Glaucoma. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5579.
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Purpose:To compare the efficacy of transcleral cyclophotocoagulation (TS–CPC), using a diode laser, between patients with primary open angle glaucoma (POAG) and patients with neovascular glaucoma (NVG). Methods:In a retrospective chart review study, 94 eyes of 94 patients with uncontrolled NVG or POAG who received TS–CPC were reviewed and analyzed. Patients included in this study had a mean follow up of 18 months. The included eyes were treated with 6–43 spots & 0.6–2.3W at an exposure time of 2 seconds using a diode laser with a focusing tip. The available data was compared preoperatively and at 1 week and 1, 3, 6, 12, and 18 months, postoperatively. Data analyzed included age, race, sex, visual acuity, intraocular pressure (IOP), and number of glaucoma meds. Results:There was no difference between groups with respect to patient demographics. There was a statistically significant difference in the pre–operative IOP between the two groups with NVG having higher pressure (NVG 39.6+/–12.8 mmHg vs. POAG 31.2+/–10.4 mmHg, P = 0.0015). There were; however, no statistically significant differences in pre–operative glaucoma medications or visual acuity. The post–op IOP decrease was statistically significant for both groups (mean IOP reduction of 14.6 mmHg for patients with NVG (P=0.0004), and 10.3 mmHg for patients with POAG at 6 months. (P≤0.0001)). The long–term success rates were defined by criterion I and criterion II. Criterion I was considered a success if the postoperative IOP decrease remained ≥3 mmHg with no additional medication, laser, or glaucoma surgery. Criterion II was considered a success if the postoperative IOP remained between 5 mm of Hg and 22 mm of Hg without additional surgery or laser. For both criterion I and criterion II, the subject was only considered a failure if the IOP was outside of the restrictions, or increases in glaucoma medication occurred on 2 or more consecutive recorded visits. The long–term success rate differences between the NVG and the POAG group were not statistically significant for criterion I or criterion II (Kaplan–Meier survival analysis log–rank p=0.8733 by criterion I and p=0.4758 by criterion II). Conclusions: Diode laser TS–CPC is an effective cyclodestructive treatment that reduces IOP in patients uncontrolled by medical management. TS–CPC appears to be equally effective in patients with NVG and POAG despite different pathophysiological reasons for elevated IOP.
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