[Effect and complications of Vogt perforating cyclodiathermy in various forms of glaucoma]

In 178 eyes 223 perforating cyclodiathermies (PCD) have been performed. The technique described by Vogt was modified by additional coagulations around the insertions of the recti-muscles. This procedure was done if one or repeated glaucoma procedures (fistulas, iridectomies or trabeculotomies) were not successful of if these surgical methods were not reasonable because of the morphological conditions of the iris and the chamber angle. If one compares in this retrospective study the average diurnal curves of 60 eyes preoperatively and 7 days postoperatively the PCD has lowered the curve and removed the morning peak that was visible preoperatively. In 153 eyes (86%) the intraocular pressure could be lowered at least for some time. A new increase was seen in most cases during the first 6 months postoperatively. 116 eyes had a postoperative follow-up of 6 months up to 3 years. 45 (39%) of these eyes were controlled without and another 31 eyes (27%) with additional medical therapy (single measurement or average of the diurnal curve less than or equal to 21 mmHG). In some eyes a repetition of the PCD was necessary to be successful. The best results had been achieved in primary glaucoma, in secondary glaucoma after uveitis and in aphacic eyes. In congenital glaucoma only 12 out of 25 eyes could be controlled and this was similar in secondary glaucoma of the vascular type. There is no influence of the preoperative pressure level on the rate of success. But the effect correlates with the preoperative visual acuity: the worse the visual function, the lower the percentage of controlled eyes. The intra-operative complications are not important. The most important postoperative complication is a phthisis bulbi which was seen in at least 10 out of 178 eyes. Most of these eyes were suffering from a secondary glaucoma of the vascular type with high preoperative pressure. All eyes had a visual acuity of 1/50 or less. To repeat the PCD after a few weeks is another factor that facilitates this serious complication. After at least 3 months the repetition of a PCD seems to be without a special risk of phthisis bulbi.