[Treatment of refractory glaucoma with trans-scleral cyclo-photocoagulation using a Diode laser]

The aim of our prospective study was to evaluate the clinical and IOP efficacy of transscleral contact cyclophotocoagulation with Diode laser in refractory glaucoma.

33 patients (mean age: 52.2 years, range: 1 to 82 years) suffering from neovascular glaucoma (n = 9), silicone oil-induced glaucoma (n = 9) or miscellaneous glaucoma (n = 15) were included in our prospective non-randomized study. The mean actual follow-up was 4.9 months (1 to 12 months). A contact Diode laser using the Oculight Six Diode laser system emitting at 810 nm with the G probe delivery (Iris Medical Instruments) was used. Cyclophotocoagulations were performed under local anesthesia in an outpatient setting (n = 26) on 270 degrees of the circumference of the ciliary body (n = 28) with the recommended parameters. Our success criteria was an IOP less than 22 mm Hg with the same visual acuity and without pain and ocular inflammation.

Except for one hypotonous eye at 1 month, no postoperative complication was observed. The pain was mild to moderate in the first postoperative days in the most cases. The ocular inflammation was mild and transitory. The mean preoperative IOP was 38.8 mm Hg (range: 25 to 60 mm Hg) and was reduced to 22.2 mm Hg (0 to 50 mm Hg) at the last examination. For all the patients, the IOP reduction was only significant at 1 and 3 months. The medication was reduced in 54.5%. According to our success criteria, we observed 15 failures and 7 retreatments. Failures were more frequent in neovascular glaucoma (n = 6/9 eyes). Nevertheless, the silicone oil induced glaucomas have the lowest IOP at the last examination (mean IOP = 16.4 mm Hg, range: 12 to 32 mm Hg) and the highest success rate (n = 7/9 eyes).

Our study confirms the findings of the previous studies and shows that Diode laser cyclophotocoagulation is a simple, effective and relatively safe procedure in comparison to the other cycloablation techniques.