Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty

Objective: This study analyzes the results of intraocular pressure (IOP) re duction by contact diode cycloablation (cyclodiode) in cases of refractory glaucoma after penetrating keratoplasty. Design: Retrospective noncomparative,interventional case series. Participants: Twenty-eight eyes in 28 patients attending the Moorfields Eye Hospital. Intervention: Cyclodiode (40 applications x 1.5 W x 1.5 seconds over 270-30 0 degrees) was used to control the IOP in refractory glaucoma after penetra ting keratoplasty. Main Outcome Measures. Postoperative IOP, graft status, visual acuity, and number of antiglaucoma medications were recorded after cyclodiode treatment . Results: Cyclodiode resulted in a reduction of IOP from a median of 33 mm Hg (interquartile range [28, 40.5]) to a median of 15 mmHg (interquartile r ange [12, 20.5]). Most patients had a significant lowering in IOP with a me dian reduction of 16 mmHg (interquartile range [12, 25]; P<0.0001). IOPs of 6 to 21 mmHg were achieved in 22 patients (79%). Sixteen patients (57%) re quired more than one treatment with cyclodiode to control the IOP, with thr ee patients (11%) requiring three treatments and two patients (7%) requirin g four treatments. Visual, acuity improved (> two Snellen lines of acuity) in three patients (11%) and remained the same (+/- one Snellen line) in 17 patients (61%). The mean number of antiglaucoma medications before cycloabl ation was 2.6 and was 1.8 after treatment (P<0.001). Of the 19 patients (68 %) with originally clear grafts, three grafts (16%) developed opacification . One patient (4%), with a history of nanophthalmos and recurrent uveal eff usion, had delayed hypotony (IOP < 6 mmHg) occurring 46 months after the di ode treatment. All patients had at least 6 months follow-up. Conclusions: These patients have often undergone multiple previous complica ted ocular interventions and. are often not suitable for filtration surgery . Reduction of IOP with maintenance of visual acuity and a good safety prof ile was achieved in most patients in this study but may require multiple tr eatments. We propose cyclodiode as an effective treatment for many patients in the management of refractory glaucoma after penetrating keratoplasty. O phthalmology 2001;108:1986-1991 (C) 2001 by the American Academy of Ophthal mology.