ENDOSCOPIC PHOTOCOAGULATION OF THE CILIARY BODY FOR TREATMENT OF REFRACTORY GLAUCOMAS

PURPOSE: To evaluate the safety and efficacy of endoscopic cyclophotoc oagulation in the treatment of refractory glaucomas. METHODS: The preo perative and postoperative courses of 68 eyes of 68 patients who under went endoscopic cyclophotocoagulation at our institution were retrospe ctively reviewed. Study patients had diverse forms of glaucoma, and mo st had failed maximal medical therapy as well as failed filtration or transscleral cyclodestructive procedures, or both. Endoscopic cyclopho tocoagulation treat ment encompassed 180 to 360 degrees of the ciliary body circumference and was performed through a limbal incision (56 ey es, 12 of which underwent concurrent cataract extraction) or pars plan a incision (12 eyes). A second laser treatment was required in five ey es (7%). RESULTS: During the mean follow-up period of 12.9 months, mea n +/- SD intraocular pressure decreased from 27.7 +/- 10.3 mm Mg preop eratively to 17.0 +/- 6.7 mm Hg at the final postoperative visit (P <. 0001), for a mean reduction of 10.7 mm Mg and a mean percent decrease of 34%. Sixty-one eyes (90%) achieved an intraocular pressure less tha n or equal to 21 mm Mg. Using this definition of success, Kaplan-Meier analysis predicted a successful outcome in 94% of patients after 1 ye ar and 82% after 2 years. The mean number of glaucoma medications used by each patient was reduced from 3.0 +/- 1.3 preoperatively to 2.0 +/ - 1.3 postoperatively (P <.0001). Best-corrected visual acuity was sta ble or improved in 64 eyes (94%), with four (6%) losing 2 or more line s of Snellen acuity. No case of hypotony (intraocular pressure <5 mm M g) or phthisis was observed. CONCLUSION: These early results suggest t hat endoscopic cyclophotocoagulation is a safe and effective therapeut ic modality for refractory glaucomas.