"Cyclodiode". Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma

To analyze the results of intraocular pressure (IOP) reduction by diode laser contact cyclophotocoagulation ("cyclodiode") in cases of advanced glaucoma refractory to alternative treatments.

Two hundred and ten eyes of 195 patients, ages 1 to 89 years (mean, 51 years) were followed for 3 to 30 months (mean, 10 months) after cyclodiode treatment.

More than one treatment was given in 102 eyes (49%), and the overall mean number of treatments given per eye was 1.75 (range, 2-5). Mean pretreatment IOP was 34.1 mmHg (+/-10.6 mmHg). At last follow-up, mean IOP was 20.1 mmHg (+/-9.3 mmHg), and mean total medications was reduced from 2.3 to 1.7. Mean final IOP was lowest in patients with silicone oil glaucoma (17.3 mmHg), and the mean reduction in IOP was greatest in patients with neovascular glaucoma (23.9 mmHg). At last follow-up, visual acuity was worse than before treatment in 29% of eyes, unchanged in 60%, and better in 11%. Overall success rate (IOP < 22 mmHg) was 66% at a mean follow-up of 10 months. Phthisis occurred in one eye (0.5%), and chronic hypotony (0 mmHg < IOP < 5 mmHg for > 3 months) in a further two eyes (1%). Corneal graft decompensation followed treatment in two eyes, macular pucker occurred in one eye, and combined hyphema/vitreous hemorrhage in one patient.

Diode laser cycloablation is relatively safe and effective at controlling IOP in eyes with advanced refractory glaucoma in the short and medium term. With the treatment parameters used, multiple applications may be needed.