Transscleral Diode Laser Cyclophotocoagulation As Primary and Secondary Surgical Treatment in Primary Open-angle and Pseudoexfoliatve Glaucoma. Long-term Clinical Outcomes

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2006 Mar 22

PMID 16550406

Citations 33

Authors

Matthias Grueb

Jens Martin Rohrbach

Karl Ulrich Bartz-Schmidt

Torsten Schlote

Affiliations

Soon will be listed here.

Abstract

Background: Transscleral diode laser cyclophotocoagulation (TDLC) has been used successfully in the treatment of refractive glaucoma. However, little is known about TDLC as a primary or secondary surgical procedure in primary open-angle and pseudoexfoliative glaucoma.

Methods: In a retrospective chart review we analyzed 90 eyes (48 OD/42 OS) in 90 patients (mean age 75 years, range 60-92 years; 51 men/39 woman) with primary open-angle glaucoma (n=66) and pseudoexfoliative glaucoma (n=24) who consecutively underwent TDLC with a minimum follow-up of 24 months. In 24 eyes (26.7%) TDLC was the primary surgical treatment. Mean energy was 80 J (60-92 J). Success was defined as a final intraocular pressure (IOP) between 4 and 18 mmHg, a minimum IOP reduction of 20% and the absence of major complications.

Results: The overall success rate was 36.7% after 24 months. A mean of 1.3 procedures was performed per patient. No correlation between age and success rate (p=0.887) or gender and success rate (p=0.895) was seen. There was no significant reduction in antiglaucomatous medication (p=0.208), no significant loss of visual acuity (p=0.324) nor a significant relationship between loss of visual acuity and failure of treatment (p=0.201). In patients with primary open-angle glaucoma the success rate was 40.9% after 24 months; in patients with pseudoexfoliative glaucoma it was 25.0% after 24 months. There was no significant difference between primary open-angle glaucoma and pseudoexfoliative glaucoma (p=0.684). Previous ocular surgery decreased the success probability from 45.8 to 33.3% (p=0.001). Prolonged hypotonia occurred in 1 patient. No phthisis bulbi developed.

Conclusions: Transscleral diode laser cyclophotocoagulation is an effective and safe method not only in the treatment of refractive glaucoma, but also as a primary surgical procedure in primary open-angle and pseudoexfoliative glaucoma. TDLC may be used more widely in glaucoma therapy, although further long-term studies have to confirm these findings.

Citing Articles

Efficacy and Safety of Diode Laser Transscleral Cyclophotocoagulation in Patients with Glaucoma.

Ribeiro M, Freitas J, Lima-Fontes M, Leuzinger-Dias M, Silva M, Araujo J Clin Ophthalmol. 2024; 18:2271-2279.

PMID: 39161366 PMC: 11330864. DOI: 10.2147/OPTH.S473788.

Outcomes of slow coagulation transscleral cyclophotocoagulation in a predominantly African American glaucoma population.

Parekh Z, Wang J, Qiu M Am J Ophthalmol Case Rep. 2024; 35:102072.

PMID: 38841152 PMC: 11152606. DOI: 10.1016/j.ajoc.2024.102072.

Endocyclophotocoagulation Combined with Phacoemulsification in Glaucoma Treatment: Five-Year Results.

Bolek B, Wylegala A, Rebkowska-Juraszek M, Wylegala E Biomedicines. 2024; 12(1).

PMID: 38255291 PMC: 10813537. DOI: 10.3390/biomedicines12010186.

Microcyclophotocoagulation in Glaucoma Treatment: A Medium-Term Follow-Up Study.

Bolek B, Wylegala A, Wylegala E J Clin Med. 2023; 12(13).

PMID: 37445376 PMC: 10342320. DOI: 10.3390/jcm12134342.

Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma.

Zemba M, Dumitrescu O, Vaida F, Dimirache E, Pistolea I, Stamate A Exp Ther Med. 2022; 23(4):278.

PMID: 35317447 PMC: 8908348. DOI: 10.3892/etm.2022.11207.

References

Egbert P, Fiadoyor S, Budenz D, Dadzie P, Byrd S . Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for primary open-angle glaucoma. Arch Ophthalmol. 2001; 119(3):345-50. DOI: 10.1001/archopht.119.3.345. View

Wong E, Chew P, Chee C, Wong J . Diode laser contact transscleral cyclophotocoagulation for refractory glaucoma in Asian patients. Am J Ophthalmol. 1997; 124(6):797-804. DOI: 10.1016/s0002-9394(14)71697-6. View

Kosoko O, Gaasterland D, POLLACK I, Enger C . Long-term outcome of initial ciliary ablation with contact diode laser transscleral cyclophotocoagulation for severe glaucoma. The Diode Laser Ciliary Ablation Study Group. Ophthalmology. 1996; 103(8):1294-302. DOI: 10.1016/s0161-6420(96)30508-3. View

Spencer A, Vernon S . "Cyclodiode": results of a standard protocol. Br J Ophthalmol. 1999; 83(3):311-6. PMC: 1722956. DOI: 10.1136/bjo.83.3.311. View

Fankhauser F, Kwasniewska S, van der Zypen E . Cyclodestructive procedures. I. Clinical and morphological aspects: a review. Ophthalmologica. 2004; 218(2):77-95. DOI: 10.1159/000076142. View

Schlote T, Derse M, Rassmann K, Nicaeus T, Dietz K, Thiel H . Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma. J Glaucoma. 2001; 10(4):294-301. DOI: 10.1097/00061198-200108000-00009. View

Brancato R, Carassa R, Bettin P, Fiori M, Trabucchi G . Contact transscleral cyclophotocoagulation with diode laser in refractory glaucoma. Eur J Ophthalmol. 1995; 5(1):32-9. DOI: 10.1177/112067219500500106. View

Feldman R, LoRusso F, McCash C, Lloyd 3rd W, Warner P . Histopathologic findings following contact transscleral semiconductor diode laser cyclophotocoagulation in a human eye. J Glaucoma. 1997; 6(2):139-40. View

Bloom P, Tsai J, Sharma K, Miller M, Rice N, Hitchings R . "Cyclodiode". Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma. Ophthalmology. 1997; 104(9):1508-19; discussion 1519-20. DOI: 10.1016/s0161-6420(97)30109-2. View

10.

Gaasterland D, POLLACK I . Initial experience with a new method of laser transscleral cyclophotocoagulation for ciliary ablation in severe glaucoma. Trans Am Ophthalmol Soc. 1992; 90:225-43; discussion 243-6. PMC: 1298436. View

11.

Threlkeld A, Johnson M . Contact transscleral diode cyclophotocoagulation for refractory glaucoma. J Glaucoma. 1999; 8(1):3-7. View

12.

Simmons R, Echelman D, Gonzales T, Veira W, Simmons R . Intraocular pressure control after contact transscleral diode cyclophotocoagulation in eyes with intractable glaucoma. J Glaucoma. 1998; 7(5):319-28. View

13.

Gupta N, Weinreb R . Diode laser transscleral cyclophotocoagulation. J Glaucoma. 1998; 6(6):426-9. View

14.

Werner A, Vick H, Guthoff R . [Cyclophotocoagulation with the diode laser. Study of long-term results]. Ophthalmologe. 1998; 95(3):176-80. DOI: 10.1007/s003470050259. View

15.

Youn J, Cox T, Herndon L, Allingham R, Shields M . A clinical comparison of transscleral cyclophotocoagulation with neodymium: YAG and semiconductor diode lasers. Am J Ophthalmol. 1998; 126(5):640-7. DOI: 10.1016/s0002-9394(98)00228-1. View

16.

Schlote T, Kreutzer B, Kriegerowski M, Knorr M, Thiel H . [Diode laser cyclophotocoagulation in treatment of therapy refractory glaucoma]. Klin Monbl Augenheilkd. 1998; 211(4):250-6. DOI: 10.1055/s-2008-1035131. View

17.

Kramp K, Guthoff R . Transscleral diode laser contact cyclophotocoagulation in the treatment of different glaucomas, also as primary surgery. Graefes Arch Clin Exp Ophthalmol. 2002; 240(9):698-703. DOI: 10.1007/s00417-002-0508-5. View

18.

Higginbotham E . Reaffirming the role of the laser in glaucoma management. Arch Ophthalmol. 1999; 117(8):1075-6. DOI: 10.1001/archopht.117.8.1075. View

19.

Mietz H, Raschka B, Krieglstein G . Risk factors for failures of trabeculectomies performed without antimetabolites. Br J Ophthalmol. 1999; 83(7):814-21. PMC: 1723106. DOI: 10.1136/bjo.83.7.814. View

20.

Becker M, Funk J . [Diode laser cyclophotocoagulation as the primary surgical intervention in glaucoma]. Ophthalmologe. 2002; 98(12):1145-8. DOI: 10.1007/s003470170005. View