Long-term results of transscleral Nd : YAG cyclophotocoagulation for refractory glaucoma postpenetrating keratoplasty

Purpose: To determine the effects of noncontact transscleral Nd:YAG cycloph otocoagulation (NCTY) in the treatment of refractory glaucoma postpenetrati ng keratoplasty (PKP) with respect to intraocular pressure (IOP), corneal g raft survival, and reduction of glaucoma medications. Methods: The records of all patients treated with NCTY for refractory glauc oma after PKP at the authors' institution over an Ii-year interval were rev iewed. The LASAG noncontact Nd:YAG laser (Lasag AG; Thun, Switzerland) was used. Approximately 40 laser applications were delivered per eye. Visual ac uity, IOP, glaucoma medications, and corneal graft clarity were evaluated. Results: Fifty-two eyes met the inclusion criterion. The mean pretreatment IOP was 38.7 +/- 11.9 mm Hg. The mean posttreatment IOP was 15.8 +/- 9.7 mm Hg. From life table analysis, the probability of having a posttreatment IO P of 21 mm Hg or less with or without medication was 70% at 1 year and 63% at 5 years. The probability of a graft remaining clear was 79% at 1 year an d 56% at 5 years. In 85% of patients the visual acuity remained stable, in 11% the visual acuity improved, and in 4% the visual acuity deteriorated af ter treatment. One patient developed hypotony. Twenty patients (36.5%) were able to discontinue one or more glaucoma medications posttreatment. Conclusion: In this group of patients with PKP glaucoma, NCTY effectively l owered IOP over the long ten, with 36.5% of patients discontinuing one or m ore glaucoma medications. There was, however, a significant incidence of gr aft failure at 5 years.