[Clinical use and results of trans-scleral Nd-YAG cyclophotocoagulation in therapy-refractory glaucoma]

We report on our results of transscleral Nd-YAG-cyclophotocoagulation on 27 eyes with refractory glaucoma. Cyclophotocoagulation was performed with similar parameters according to our findings of morphological investigation in normal human donor eyes. 9 eyes had hemorrhagic glaucoma, 10 eyes had secondary glaucoma after intraocular silicone oil tamponade because of proliferative diabetic retinopathy or because of complicated retinal detachment with proliferative vitreoretinopathy. None of the patients in this group had silicone oil in the anterior chamber, silicone oil emulsification and only one eye had rubeosis iridis. The third group of 8 eyes had glaucoma with aniridia, post-traumatic or postinflammatory glaucoma, glaucoma after extraction of a congenital cataract and one eye with an absolute painful pseudoexfoliation glaucoma. The effects were applied coaxially through the conjunctiva at 1 to 1.5 mm distance from the limbus. The energy was between 3.8 and 4.2 Joules, the exposure time was 10 ms. The focus of the laser beam was placed 3.6 mm posteriorly with a focus adjustment of 9 at the LASAG Microruptur 2. The mean postoperative observation period was 7.5 months. Among the group of hemorrhagic glaucomas the intraocular pressure could in 78% be lowered below 22 mmHg, in 60% among the secondary glaucomas after intraocular silicone oil application and in 50% among the heterogenous third group. In eyes with preceding cyclocryocoagulation 82% fulfilled this criterion. The intraocular pressure stayed stable after 4 weeks at a mean level of 40% below the preoperative values. In all cases the intraocular pressure was at least lowered by 14 mmHg. Vision was reduced in three eyes by the underlying disease.(ABSTRACT TRUNCATED AT 250 WORDS)