Transscleral neodymium:YAG cyclophotocoagulation: comparison of 180-degree and 360-degree initial treatments

In order to help clarify how much Neodymium:YAG transscleral cyclophotocoagulation (Nd:YAG CPC) treatment should be given to maximize effectiveness and minimize complications in the treatment of refractory glaucomas, we retrospectively reviewed and compared the results achieved with an initial 180-degree noncontact Nd:YAG CPC treatment with those achieved with an initial 360-degree treatment. Forty-five patients were in the 180-degree group and 21 in the 360-degree group. Mean follow up after the first Nd:YAG CPC treatment was 10.2 +/- 7.5 months. The average pretreatment intraocular pressure (IOP) in the 180-degree group was 33.5 mm Hg. After one treatment, IOP in these patients dropped an average of 8.4 mm Hg and was controlled successfully (5 to 22 mm Hg) in 14 (31%). After a mean of 2.0 treatments, IOP in these patients dropped an average of 15.3 mm Hg, and successful IOP control was ultimately achieved in 35 (78%). The average pretreatment IOP in the 360-degree group was 41.8 mm Hg. After one treatment, IOP in these patients dropped an average of 19.4 mm Hg and was controlled successfully in 11 (52%). After a mean of 1.3 treatments, IOP in these patients dropped an average of 20.7 mm Hg, and successful IOP control was ultimately achieved in 13 (62%). Our study suggests that repeated 180-degree treatments can be successful. However, because we found that IOP was controlled more rapidly with fewer major complications in the 360-degree group, the risk-to-benefit ratio may be better for initial 360-degree treatment.