Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma

Background: This prospective study was conducted to evaluate the efficacy a nd safety of transscleral diode laser cyclophotocoagulation in refractory, advanced glaucoma. Patients and Methods: One hundred eyes of 100 patients with advanced glauco ma refractory to medical treatment were consecutively treated by transscler al diode laser cyclophotocoagulation. Success was defined as a final intrao cular pressure between 5 and 21 mm Hg in eyes with a visual acuity of more than hard movements, relief of pain in eyes with a visual acuity of hand mo vements or less including blind eyes, and reduction of carbonic anhydrase i nhibitor use in all eyes. Results: Ninety-three patients were followed up for 1 year after initial tr eatment. The overall success rate was 74.2%. Of 60 eyes with a visual acuit y of more than hand movements, intraocular pressure between 5 and 21 min Hg was achieved in 41 (68.3%) eyes. Relief of pain was achieved in 28 (84.8%) of 33 eyes. Reduction of systemic carbonic anhydrase inhibitor use was hig hly significant (P < 0.0001). Within 1 year, 173 laser procedures (mean, 1. 9 per patient) were performed. The probability of success increased signifi cantly (P 0.004) with the age of the patients, from 55% for patients younge r than the age of 50 years to 83% for patients older than the age of 50 yea rs. Previous ocular surgery decreased the success probability from 95% to 6 8% (P = 0.02), A high success rate was achieved in inflammatory glaucoma (7 5%). primary open-angle glaucoma (89.5%), and neovascular glaucoma (86.7%). The results were relatively poor in traumatic glaucoma (57.1%), aphakic gl aucoma (57.1%), and congenital or juvenile glaucoma (62.5%). No significant relationship between loss of visual acuity and failure of treatment (P = 0 .3) could be detected. No phthisis bulbi or persistent hypotonia developed. Conclusions: Transscleral diode laser cyclophotocoagulation is an effective and safe method for the treatment of advanced, refractory glaucoma. Howeve r, repeated treatments are often necessary. Success of treatment depends on the age of patients, previous surgery, and the type of glaucoma.