Diode Laser Transscleral Cyclophotocoagulation as Primary Surgical Treatment for Medically Uncontrolled Chronic Angle Closure Glaucoma

Abstract

Diode laser cyclophotocoagulation appeared to be an effective and safe primary surgical treatment of medically uncontrolled chronic angle closure glaucoma, with intraocular pressure-lowering effect persisting for up to two years.

Long-term efficacy and visual acuity following transscleral diode laser photocoagulation in cases of refractory and non-refractory glaucoma

“…The reason for cyclodestructive procedures not being widely used as a primary procedure in seeing eyes was because of complications reported in very early studies. 8,9 This study confirms the findings of previous studies, [1][2][3][4][5][6][7][8][9] which demonstrated safety and efficacy to reduce IOP in complex cases. Furthermore, it confirms efficacy and preservation of visual function in patients with good VA pre-laser.…”

“…Mean IOP was significantly reduced by 45.1% (40.3-21.1 mmHg) (P ¼ 0.005, paired t-test). This compares favourably with other studies, [1][2][3][4][5][6][7][8][9] although direct comparisons are difficult because of different study populations and treatment protocols. 4 Other cyclodestructive procedures (cyclocryotherapy, Nd:YAG cycloablation) are associated with reduction of IOP ranging between 43 and 51% with 12-30 months follow-up, 10,11 although there are more side-effects and vision loss with those methods.…”

“…[1][2][3][4][5] Recently it has gained attention as a modality for treatment of glaucoma cases with good vision, and even as a primary surgical treatment in some situations, [5][6] thereby establishing a broader role for TSCP. We report the long-term efficacy and safety data in a group of glaucoma patients, with particular emphasis on the long-term preservation of VA in those with ambulatory vision (6/36 or better) pretreatment.…”

“…As in our study, the visual decline was attributed to cataract and progression of GON. 6 Recent studies have been conducted on the earlier use of TSCP including those cases with good VA. A retrospective study of 21 eyes with VA 20/80 or better demonstrated that in most cases VA was preserved post TSCP. 14 In a study in Ghana, TSCP was used as primary surgical treatment.…”

Cyclodestructive Procedures

“…7,11 Diode laser cyclophotocoagulation appeared to be an effective and safe primary surgical treatment of medically uncontrolled chronic angle closure glaucoma, with intraocular pressure lowering effect persisting for up to two years. 16 TSCPC has a significant ocular hypotensive effect on glaucoma refractory to both tube shunt and medical therapy. 17 An unqualified success after cycloablation would be the attainment of a target IOP without the need for further medication, coupled with preservation of visual function.…”