Diode laser cyclophotocoagulation versus cyclocryotherapy in the treatment of refractory glaucoma

The aim of the present study was to evaluate the efficacy of diode laser cyclophotocoagulation (DCPC) and cyclocryotherapy (CCT) in the treatment of refractory glaucoma and compare the postoperative complications and discomfort rates.

In a prospective, randomized, controlled clinical study, 40 eyes of 40 patients with refractory glaucoma were randomly assigned in 2 groups of 20 eyes each to receive either DCPC or CCT. Patients underwent follow-up examinations on the first 3 days and then 1 week and 1, 3, 6, and 12 months after initial treatment. Complications and discomfort after treatment using a visual pain analogue scale were recorded.

In the DCPC group, the mean intraocular pressure (IOP) decreased (p<0.05) from 44.3 ± 16.4 mmHg preoperatively to 24.1 ± 7.6 mmHg, 22.8 ± 5.6 mmHg, and 22.5 ± 5.1 mmHg 3, 6, and 12 months posttreatment, respectively. Regarding the CCT group, the mean IOP was reduced (p<0.05) from 46.5 ± 10.4 mmHg to 26.6 ± 12.2 mmHg, 21.2 ± 7.7 mmHg, and 20.6 ± 5 mmHg at the same time intervals. In the DCPC group, the mean IOP reduction was strongly correlated with the number of laser effects (r = 0.65; p<0.01), but 35% needed retreatments. The mean postoperative pain was 5.6 ± 2.9 (DCPC) vs 5.7 ± 2.3 (CCT) (p = 0.91). No severe complications were observed.

Both DCPC and CCT proved to be safe and effective IOP-lowering methods in patients with refractory glaucoma. Diode laser cyclophotocoagulation should be considered as the primary treatment option in refractory glaucoma using an individual treatment dosage.