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Vikas Tah, Saruban Pasu, Sanjay Shah; Retrospective review of patients with refractory glaucoma treated with Transcleral Diode Laser Cyclophotocoagulation. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4792.
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To report the efficacy and safety of cyclodiode laser therapy in the management of refractory glaucoma over a 5 year period in a single centre at St Helliers Hospital in Sutton of London .
A retrospective review was undertaken of patients who at undergone transcleral diode laser cyclophotocoagulation at St Helier Hospital. Records were obtained from the theatre log book and patient notes then tracked and reviewed. Laser settings were recorded, along with visual acuties, intraocular pressure (IOP) and initiation of pressure lowering drops. Complications were noted along with copatholgies over a 5 year period.
96 eyes were treated between March 2000 - October 2007. Mean age 70 years old. 61% were male. Mean settings: 40.1 shots, 1500mW power and 1500ms duration. Mean energy delivered was 90.2 Joules. Primary outcome of success was IOP between 5 and 21mmHg or a 30% reduction from baseline. At 6 month review 66% were successful, at 1 year 83% and at 2 and 5 years 80%. The IOP reduction was 52% at 1 week, 40% at 1 and 6 months, 53% at 1 year, 56% at 2 years and 45% at 5 years. 18 (37%) eyes saw 6/60 or better prior to treatment. Of these, 2 lost vision of 2 lines or more. Overall, there was a 32% drop in the number of glaucoma medications over the 5 year period. 19 patients were on oral acetazolamide pre treatment, 10 of which remained on oral acetazolamide post treatment. 1 patient developed post procedure anterior uveitis (on a background of fuchs heterchromic cyclitis), while two patients were hypotonous at the 5 year follow up.
Cyclodiode remains a useful adjunctive treatment for refractory glaucoma. Our review showed a sustained decrease in IOP and reduction in the use of IOP-lowering drops following treatment. Our data was comparable to that of the UK National Cyclodiode Laser Survey 2011. Historically used only in non-seeing eyes, we have shown it can be safely and effectively used in sighted patients. Conclusion: We propose that cyclodiode may be safely used in seeing and non-seeing eyes, and suggest its use be considered on a case-by-case basis, offered as a potential lower risk treatment in higher risk patients.
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