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Samantha Dewundara, Bret Hughes, Rominder Momi, Justin Tannir, Chaesik Kim; Predictors of Failure with Transscleral Diode Laser Cyclophotocoagulation in the Treatment of Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1858.
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This study was conducted to evaluate prognostic indicators for failure with transscleral diode laser cyclophotocoagulation (TSDLCP) in the treatment of refractory glaucoma
This retrospective study analyzed 100 eyes in 100 patients with glaucoma refractory to conventional medical and/or surgical management and subsequently treated with TSDLCP. Failure in treatment was defined as intraocular pressure (IOP) measured < 5 or >22 mmHg, increase in number of antiglaucoma medications and need for additional diode or incisional surgery. Prognostic variables analyzed include patient age, sex, race, diagnosis of diabetes, diagnosis or hypertension, type of glaucoma, number of pre-laser IOP lowering medications used and pre-laser IOP. Data were analyzed using Cox regression and Kaplan-Meier Survival analysis.
Mean patient age was 63±17 years (range 24-89 years). Fifty males and fifty females were studied. With respect to race, 71 African-Americans, 19 Caucasians and 10 other races were studied. Patients had chronic open-angle glaucoma (n=43), chronic angle-closure glaucoma (n=25), neovascular glaucoma (n=22) and other forms of glaucoma (n=10). Forty patients were diagnosed with diabetes mellitus and 72 with hypertension. Average pre-laser IOP was 37 ±12 mmHg. Mean follow up was 12 ± 10 months. Patients received 20 ± 6 laser applications per session, each application lasting 2 seconds in duration, ranging from 180-360 degrees. Total laser energy delivered per eye was 38 ±14 Watts. A success of 45% was noted at mean follow up of 12 months using Kaplan -Meier survival analysis, with a mean post-treatment IOP of 22 ±12mmHg at 12 months (P<0.05). Age, sex, race, diabetes, hypertension, type of glaucoma, number of pre-laser IOP lowering medications used and pre-laser IOP were not prognostic indicators of treatment failure (COX regression analysis, P>0.05).
With significant reductions in IOP, TSDLCP is a safe and effective alternate treatment for refractory glaucoma. Age, sex, race, diabetes, hypertension, type of glaucoma, number of pre-laser IOP lowering medications used and pre-laser IOP do not appear to impact success of treatment.
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