Diode laser cyclophotocoagulation in refractory glaucoma

Purpose: To evaluate the effect of contact transscleral diode cyclophotocoagulation for refractory glaucoma. Methods: Thirty-three patients with intractable glaucoma were treated with contact diode cyclophotocoagulation. Laser radiation (810 -nm) was delivered to the eye by a fiberoptic (G-probe) placed 1.2 mm behind the limbus. Laser setting used was 2 W power for the duration of 2 seconds. Forty to 45 laser spots were applied over 360 degrees. Intraocular pressure (IOP), the number of glaucoma medications, visual acuity and complications were all assessed at last follow-up visit 12 months after laser treatment. Success was defined as IOP of less than 22 mmHg with medications at the last follow-up visit. Results: The mean IOP decreased from 37.8±8.0 mmHg pre-diode treatment to 18.2±9.2 mmHg at last follow-up visit after treatment (p<0.05). About 73% of patients achieved IOP of between 2 and 22 mmHg at final follow-up. The mean number of medications required decreased from 3.4±1.1 before to 2.4±1 after treatment (p<0.05). Fifty five percent of the patients had a deterioration in visual acuity. Other complications were few and included transient hyphema, uveitis, choroidal detachment and hypotony. Conclusion: Contact transscleral diode cyclophotocoagulation is effective in lowering IOP and reducing the number of glaucoma medications in refractory glaucoma. The deterioration in visual acuity post-laser is a limitation of the treatment.