Diode laser cyclophotocoagulation in refractory glaucoma

Background It has been suggested that Nd:YAG laser cyclophotocoagulation significantly lowers the intraocular pressure in refractory glaucoma. However, only limited information is currently available concerning the cyclodestructive effects of diode laser cyclophotocoagulation. Patients and Methods Twenty eyes of 17 patients had undergone diode laser cyclophotocoagulation if previous glaucoma surgery including cyclophotocoagulation was unsuccessful or the patients were blind. Nine eyes had secondary glaucoma, 5 neovascular glaucoma, 5 congenital glaucoma, and 1 eye chronic open angle glaucoma. Treatment was applied in two quadrants using a 810 nm diode laser (600 qm diameter quartz fiber, 2 sec, 1.75-3 W, 6 to 10 pulses). Seven eyes required retreatment. Results In 19 eyes the baseline IOP was 32.1+/-10.1 mm Hg and at the patient's last examination 21.0+/-8.4 mm Hg. Median follow up was 11 months (3 to 19 months). In 3 of 5 eyes with a visual acuity of less than 1/50 IOP was desreased under 30 mm Hg, while 9 of 14 eyes with a visual acuity of at least 1/50 IOP revealed a decrease of IOP under 20 mm Hg, resulting in a success rate of 68%. Complications included acute severe anterior uveitis in one eye and bulbus hypotonia in another for several months. After three weeks, one eye was enucleated because of persisting high IOP and pain. Histopathologically, coagulation necrosis of the ciliary body stroma and separation of epithelial layers were observed. Conclusions This study suggests that contact diode laser cyclophotocoagulation is an effective method and a valid alternative to cyclocryocoagulation in the treatment of refractory glaucoma including congenital glaucoma.