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N. K. Wride, M. Zolotar, A. J. Hildreth, M. Birch, F. C. Figueiredo; Contact Cyclodiode Laser Treatment for Refractory Glaucoma After Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4683.
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© ARVO (1962-2015); The Authors (2016-present)
Refractory glaucoma after penetrating keratoplasty can be difficult to treat with patients often requiring multiple procedures. Our aim was to study the safety and efficacy of contact semiconductor laser cyclophotocoagulation, ‘cyclodiode laser’ in eyes with refractory glaucoma after penetrating keratoplasty.
A retrospective, single-centre study of consecutive patients treated with cyclodiode laser for refractory glaucoma following penetrating keratoplasty (PKP) in a tertiary corneal transplantation service in the United Kingdom. Patients were identified from the PKP database between March 1997 and October 2006. The PKP procedures had been performed by a single surgeon (FCF) and the cyclodiode laser treatment was performed by the glaucoma service under a single surgeon (MB).
Twenty consecutive eyes of 20 patients were identified from the database. The mean follow-up period was 37 months (range 4 -72 months). Mean age of patients was 69 years (range 34-94). The mean number of cyclodiode treatments used was 1.7 (range 1-4). Eleven eyes required only one cyclodiode treatment to control IOP. A reduction in intraocular pressure (IOP) from a mean of 22.30mmHg to 16.35mmHg (p=0.014) was observed. The median number of medications required pre-cyclodiode was 4 and post-treatment was 2 showing a significant reduction (p<0.0001). Sixteen (80%) eyes had a reduction in the number of medications with 2 eyes requiring no treatment to control the IOP. Visual acuity (VA) remained unchanged (+/- one Snellen line of acuity) in 13 eyes (65%) and was reduced in 6 eyes (>2 lines of Snellen acuity). However, this observed deterioration in VA did not reach statistical significance (p=0.175). There was one episode of graft rejection after cyclodiode which settled rapidly on treatment. None of the subsequent graft failures (n=4) could be attributed directly to the cyclodiode laser treatment. There were no instances of phthisis or hypotony during the follow up period.
Our study demonstrates that cyclodiode laser can deliver significant reduction in IOP and requirement of anti-glaucoma medications, with maintenance of VA and a good safety profile in most patients. We propose that cyclodiode laser is a useful and safe therapeutic option in this group of patients.
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