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Samantha S Dewundara, Bret Hughes, Saya Nagori, Aman Shukairy, Justin Tannir, Anju Goyal, Mark S Juzych, Chaesik Kim; Impact of Glaucoma Type on the Success of Transscleral Diode Laser Cyclophotocoagulation in the Treatment of Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6166.
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This study was conducted to evaluate the impact of the type of glaucoma on the success of treatment with transscleral diode laser cyclophotocoagulation (TSDLCP) in refractory glaucoma.
This retrospective study analyzed 90 eyes in 90 patients with glaucoma refractory to conventional medical and/or surgical management and thereafter treated with TSDLCP. With respect to type of glaucoma, 43 eyes with chronic open angle glaucoma (OAG), 25 eyes with chronic angle-closure glaucoma (ACG) and 22 eyes with neovascular glaucoma (NVG) were studied. Success in treatment was defined as IOP measured between 5-22mmHg with no increase in number of antiglaucoma medications and no additional diode or incisional surgery.
Mean follow up for patients with OAG was 13±2 months, ACG 19±3 months and 8±1 months for NVG. There was no statistically significant difference in total energy delivered per eye and patients of all three groups received 20 ± 6 laser applications per session, each lasting 2 seconds in duration, ranging from 180-360 degrees. Patients received one treatment session per eye. Mean pretreatment IOP was 34.6±10.1mmHg for OAG, 37.6±10.1mmHg for ACG and 38.9±12.3mmHg for NVG (P>0.05). At 24 months follow up, mean post-treatment IOP was significantly reduced across all types of glaucoma. Mean post-treatment IOP at 24 months was 18.1±8.8mmHg for OAG, 25.0±12.3mmHg for ACG and 22.4±9.0mmHg for NVG (P>0.05). There was no statistically significant difference in the IOP lowering effect of TSDLCP across the different types of glaucoma and all follow up time points. At 15 months follow up, a success of 39% was noted for eyes with OAG, 53% for ACG and 17% for NVG. Of the ten eyes requiring additional incisional surgery, 60% of those eyes had NVG (P<0.05).
With significant reductions in IOP, TSDLCP is an effective treatment for refractory glaucoma, independent of glaucoma type. When assessing success of treatment in a clinical setting, ACG yielded the best results, followed by OAG and then NVG. Interestingly, of patients requiring additional incisional surgical intervention, eyes with NVG were more common.
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