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Harry A Quigley; Success in diode ciliodestruction is greater with personalized energy delivery Review of 236 treated eyes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3462. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the success and complications from diode ciliodestruction (CD) procedures and the delivery parameters that were more likely to be successful.
Retrospective data review of all external CD procedures performed at the Wilmer Institute, Johns Hopkins from 2006-2015 by 5 faculty surgeons, using the glaucoma probe delivery to the perilimbal zone. Success was defined by achieving a set target intraocular pressure (IOP) or, IOP lowering to <21 mm Hg plus 20% lowering from preoperative IOP. Adverse outcomes of phthisis and enucleation were logged.
Mean followup time was 3.3 years. In eyes receiving only 1 CD, success was achieved in 74% (n=180 eyes). 18% had 2-4 CD treatments, with overall success of 70% (n=236 eyes). Nine eyes were enucleated and 5 developed phthisis, most often due to non-glaucoma causes. 82% achieved elimination of preoperative pain (32/39). Immediate postoperative pain was mild (<3/10 in 86% day 1). Success was highest in procedures using audible clues to select and vary the optimal power (82%), while procedures in which the same power (total joules) was used in all eyes had the lowest success (49%; p<0.02). Success did not differ significantly by glaucoma type (open angle vs all other; p=0.08). Phthisis coincided with low IOP in 2 eyes.
In advanced open angle and secondary glaucoma, CD achieved IOP lowering and pain control satisfactorily, but vision loss from non-glaucoma causes was frequent and multiple treatments were sometimes required. Use of the same laser protocol in all eyes was less successful than tailoring total energy to audible events within the eye. Newer delivery methods for diode lasers using a standardized protocol may suffer from a lack of personalized treatment parameters.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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