O. Kosoko et al., LONG-TERM OUTCOME OF INITIAL CILIARY ABLATION WITH CONTACT DIODE-LASER TRANSSCLERAL CYCLOPHOTOCOAGULATION FOR SEVERE GLAUCOMA, Ophthalmology, 103(8), 1996, pp. 1294-1302
Purpose: To learn the long-term outcome of ciliary ablation with diode
laser contact transscleral cyclophotocoagulation (TSCPC) in eyes with
recalcitrant, severe glaucoma. Methods: Twenty-seven eyes of 27 patie
nts with medically and surgically uncontrollable glaucoma and no previ
ous ciliary ablation enrolled in this study. After baseline measuremen
ts and informed consent, the authors performed contact TSCPC. There we
re 14 pseudophakic, 7 aphakic, and 6 phakic eyes; 15 of these had prim
ary open-angle glaucoma and the remainder had various secondary or ope
n- or closed-angle glaucomas. Median follow-up was 19 months (range, 6
weeks to 27 months). initially after laser surgery, glaucoma medicati
ons were continued, except for a 2-week interruption of miotics; the o
phthalmologist later adjusted medications in accordance with the patie
nt's status. The authors define failure of TSCPC in two ways, based on
IOP measurements during two consecutive study examinations 6 weeks or
more after intervention or at the final examination: (1) less than 20
% intraocular pressure (IOP) reduction from baseline, and (2) either l
ess than 20% reduction of IOP from baseline or IOP greater than 22 mmH
g. Results: For 27 eyes, the baseline IOP (mean +/- standard deviation
) was 36.4 +/- 12.4 mmHg (range, 20-70 mmHg). The mean IOP at last exa
mination was 20.3 +/- 8.7 mmHg. With failure definition 1, the cumulat
ive probability of success was 84% at 1 year and 62% at 2 years. With
failure definition 2 the cumulative probability of success was 72% at
1 year and 52% at 2 years. At the last examination, 19 eyes (70%) had
visual acuity improved within one line of visual acuity at eligibility
. One of these eyes, with light perception vision at entry, declined t
o no light perception. Three eyes (11%) lost two lines of vision and f
ive (19%) lost three or more lines. Conclusions: Contact diode laser T
SCPC yields long-term improvement of IOP and preservation of visual ac
uity in a substantial proportion of eyes with severe, medically uncont
rolled glaucoma.