Management of refractory glaucoma using fixed-energy diode laser cyclophotocoagulation

Abstract

Purpose The aim of this study was to evaluate the efficacy and safety of trans-scleral diode laser cyclophotocoagulation (TSCPC) using the fixed-energy technique in the management of patients with refractory glaucoma. Patients and methods In this prospective study, 22 eyes of 22 adult patients with refractory glaucoma and visual acuity of less than or equal to 3/60 (≥1.3 logMAR) were included. Following complete ophthalmological examination, patients were treated with TSCPC using the slow coagulation technique. Follow-up of patients was done at 1 week, 1 month, 3 months, and 6 months, postoperatively. Postoperative complications were monitored and reported. Results The mean age of patients was 57.1±10.6 years. There was no significant change in visual acuity or optic disk appearance between preoperative and postoperative visits in all cases. There was a significant reduction in mean intraocular pressure after 6 months of follow-up from 42.41±8.8 mmHg, preoperatively to 18.5±8.8 mmHg, postoperatively (P=0.02). The mean number of antiglaucoma medications was reduced significantly from 2.45±1.1, preoperatively, to 1.0±0.5, postoperatively (P=0.0001). Mild to moderate anterior chamber reaction was reported in 16 (72.7%) patients while hyphema was found in two (9%) patients and vitreous hemorrhage and transient hypotony due to choroidal detachment were encountered in one patient each. Six (27.27%) patients reported smooth postoperative course without any complications or pain. Conclusion Fixed energy method of TSCPC represents an effective technique for the management of refractory glaucoma with low potential for serious complications.

Keywords

• cyclophotocoagulation
• diode laser
• intraocular pressure
• refractory glaucoma
• trans-scleral diode