CONTACT TRANSSCLERAL CYCLOPHOTOCOAGULATIO N WITH DIODE-LASER IN REFRACTORY GLAUCOMA - A MID-TERM FOLLOW-UP-STUDY - ANALYSIS OF 50 PATIENTS FOLLOWED OVER 19 MONTHS

Purpose To evaluate the effects of transscleral cyclophotocoagulation with the diode laser for refractory glaucoma with respect to intra-ocu lar pressure, reduction of medical therapy and complications. Methods The diode laser system (Iris Medical Instrument, Oculight SLX) was use d to treat 50 eyes of 47 patients with therapy resistant glaucoma and a poor prognosis with filtering surgery. All eyes and maximal hypotoni c therapy and 40 (82 %) patients were using carbonic anhydrase inhibit ors. Laser energy was delivered to the eye through a quartz glass fibe r optic probe [13 to 20 spots over 270 degrees using 3.5J (1.75 W x 2. 0 sec)]. The mean follow-up was 19.4 +/- 9.1 months (from 12 to 29 mon ths). Results Intra-ocular pressure significantly decreased from mean baseline 32.4 +/- 9.1 mmHg to 19.7 +/- 8.1 mmHg at the end of the foll ow-up (p < 0.001). An intra-ocular-pressure below 20 mmHg was obtained in 66 % of the eyes. In 13 patients the carbonic anhydrase inhibitors were discontinued. Six of the 8 painful eyes had pain relief. Visual acuity decreased in 17 (34 %): contaract progression in 5 eyes, uncont rolled intra-ocular-pressure in 4 eyes, glaucoma progression despite c ontrolled intra-ocular-pressure in 3 eyes, corneal dystrophy in 3 eyes . Chronic uveitis occurred in 5 (10%) eyes. No conjonctival, scleral o r direct lens damage was detected. Conclusion Contact transscleral cyl ophotocoagulation with the diode laser system can be successfully used to reduce intra-ocular-pressure in therapy resistant glaucoma. The in cidence of complications is low with no loss of vision related to cycl odestruction.