Effect of diode laser cyclophotocoagulation in treatment of patients with refractory glaucoma

Refractory glaucoma is glaucoma resistant to conventional management (maximally tolerated medical therapy, one or more glaucoma surgeries) and glaucoma in cases of neovascularisation after panretinal photocoagulation or cryoablation. The aim of the study was to determine the intraocular pressure (IOP) lowering efficacy of transscleral diode laser cyclophotocoagulation (DCPC) treatment in the management of pain and IOP in patients with refractory glaucoma.

This nonrandomized, retrospective study, included 95 patients (95 eyes) with refractory glaucoma treated at the University Eye Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia, between November 2007 and November 2012 in accordance with the established protocols (16-18 spots, 270°, up to 5J of energy). All the eyes were treated with transscleral DCPC (Iris Medical OcuLight SLx, Iridex Co, Mountain View, USA). Patient's symptoms, bests corrected visual acuity and IOP were recorded 7 days, and 1, 3 and 6 months after the DCPC treatment.

Out of 95 patients (95 eyes) enrolled in this study 24 (25.2%) were with primary (the group I), and 71 (74.5%) with secondary (the group II) glaucoma. The mean baseline IOP in these two groups was similar: 36.08 ± 8.39 mmHg for the first group and 37.36 ± 8.19 mmHg in the second group. Measurement of the mean IOP in the group I showed the following results: on the day 7 it was 13.96 ± 8.30 mmHg (62.1% decrease of the baseline value), on the day 30 it was 18.44 ± 8.85 mmHg (48.9% decrease regarding the baseline value), after 3 months it was 22.44 ± 7.36 mmHg (37.8% decrease regarding the baseline value), and after 6 months it was 25.92 ± 7.65 mmHg (28.2% decrease regarding the baseline value). Measurement of IOP in the group II showed the following results: on the day 7 it was 15.77 ± 9.73 mmHg (57.8% decrease of the baseline value), on the day 30 it was 20.14 ± 10.20 mmHg (46.1% decrease regarding the baseline value), after 3 months it was 23.46 ± 9.83 mmHg (37.2% decrease regarding the baseline value) and after 6 months it was 27.23 ± 9.87 mmHg (27.2% decrease regarding the baseline value). Pain was the main symptom in 70 (73.6%) patients before the treatment and it persisted in only 4 (4.2%) of our patients. Other complaints (burning, stinging, foreign body sensation) were experienced by 39 (41%) of the patients, postoperatively. A total of 52 (54.7%) patients had no com- plaints after the treatment.

Our study confirmed that transscleral DCPC is a useful, effective and safe procedure with predictable amount of IOP decrease, which makes it the treatment of choice for refractory glaucoma.