LONG-TERM OUTCOME OF INITIAL CILIARY ABLATION WITH CONTACT DIODE-LASER TRANSSCLERAL CYCLOPHOTOCOAGULATION FOR SEVERE GLAUCOMA

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.