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S. S. Dewundara, B. A. Hughes, A. Goyal, M. S. Juzych, M. Y. Alexander, S. Ali, D. A. Feldman, O. Warritay, C. Kim; Outcomes of Diode Laser Cyclophotocoagulation in the Treatment of Refractory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4433.
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This study was conducted to evaluate the outcomes and complications of diode laser cyclophotocoagulation (DLCP) in refractory glaucoma.
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.
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.
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.
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