Abstract
Abstract: :
Purpose: To describe our experience combining diode cilioablation and trans–scleral diode retinal photocoagulation in eyes with neovascular glaucoma. Methods: Retrospective chart review of 26 patients receiving 28 combined diode treatments over a 4.5–year period. Using the Iris diode laser, cilioablation was carried out using the G–probe and settings of 2000 ms and 3000 mW (titrated downward to achieve about 1 pop per 3 spots), around the limbal circumference but avoiding the 3:00 and 9:00 positions; and retinal photocoagulation using the trans–scleral probe and settings of 1500 ms and 2000 mW, placed in three rows strattling the equator of the globe in all four quadrants. Acuity, IOP, medication use, and treatment parameters were recorded. Results: No patient had pre–operative acuity better then 20/400, and 5 patients were NLP pre–op. Mean pre–op IOP was 35.6 mmHg (range 20–60) on a mean of 1.8 IOP–lowering medications. Cilioablation averaged 21.6 treatment spots (range 5–28), and retinal photocoagulation averaged 55.3 treatment spots (range 36–80). After mean follow–up of 12.3 months (range 1–60), mean IOP fell to 18.1 mmHg (range 2–48; 16/26 eyes (62%) with IOP between 5 and 22 mmHg) on a mean of 0.9 medications. IOP reduction was achieved quickly: mean IOP on the first post–op visit (average 11 days after treatment) was 18.9 mmHg (range 3–46). Final visual acuity was better than 20/400 in 3 patients, and 11 patients were NLP. Complications of combined diode cilioablation and retinal photocoagulation included phthisis in 8 patients, repeat treatment in 2 patients, and 1 patient each experienced hyphema, lagophthalmos, transient flat anterior chamber, cataract, and band keratopathy. Conclusions: Combined diode cilioablation and trans–scleral retinal photocoagulation can quickly and effectively produce long–term IOP control in eyes with neovascular glaucoma consistent with other treatment modalities. This technique is a reasonable approach in eyes with poor media clarity, as visualization of the posterior segment is not required.
Keywords: laser • clinical (human) or epidemiologic studies: outcomes/complications