Outcomes of Diode Laser Cyclophotocoagulation in the Treatment of Refractory Glaucoma

Abstract

Purpose: : This study was conducted to evaluate the outcomes and complications of diode laser cyclophotocoagulation (DLCP) in refractory glaucoma.

Methods: : This retrospective study analyzed 70 eyes in 68 patients with glaucoma refractory to conventional medical and/or surgical management and thereafter treated with DLCP. Patients studied had chronic open-angle glaucoma (n = 29), chronic angle-closure glaucoma (n = 20), neovascular glaucoma (n = 14) or other (n = 7) forms of glaucoma including congenital glaucoma. Patients received one treatment session per eye. Success was defined as IOP measured between 5-22 mmHg with no increase in number of antiglaucoma medications and no additional diode or incisional surgery.

Results: : Mean patient age was 63 ± 18 years (range 24 - 88 years). Thirty-six males (51%) and 34 females (49%) were studied. With respect to race, there were 47 African-Americans (67%), 15 Caucasians (21%), and 8 other (11%). Mean follow-up was 12 ± 11 months. Total laser energy delivered per eye was 38 ± 14 Watts. Patients received 20 ± 6 laser applications per session, each lasting 2 seconds in duration, ranging from 180 - 360 degrees. Mean pretreatment IOP was 37 ± 12 mmHg and mean post-treatment IOP at 24 months was 19 ± 9 mmHg (P=0.002). Mean number of antiglaucoma medications used decreased from 3.1 ± 1.1 to 2.2 ± 0.4 by 24 months (P<0.05). A success of 42% was noted at median follow up of nine months. There was no difference with respect to type of glaucoma and success of treatment (P>0.05). Median pretreatment visual acuity was hand motion and median post-treatment visual acuity was light perception at 9 months follow up (P=0.025). Persistent hypotony developed in four eyes (5.7%) within one month post-treatment.

Conclusions: : With significant reductions in IOP and number of medications, DLCP is a safe and effective alternate treatment for refractory glaucoma. However, visual acuity may be affected nine months post-treatment. Type of glaucoma did not impact success of treatment. Hypotony is the most common complication and developed within one month post-treatment.

Keywords: inflow/ciliary body • intraocular pressure • laser