title: Neodymium: YAG laser transscleral cyclophotocoagulation for glaucoma after penetrating keratoplasty.
abstract: Nd:YAG laser cyclophotocoagulation (CPC) of the ciliary body is a promising cyclodestructive treatment for the management of refractory glaucoma following penetrating keratoplasty. Twenty-eight eyes (27 patients) were treated between August 1985 and September 1987 and followed 6 to 24 months (median, 18 months). The mean intraocular pressure (IOP) was initially 39 mm Hg (range, 30 to 70 mm Hg) on maximally tolerated medications. The Lasag Microrupter 2 was used in the free-running thermal mode with a mean pulse energy of 4.13 J. The laser was retrofocused 3.6 mm from the conjunctival surface and 30 to 50 applications per treatment (mean, 37.5) were given 2 to 3 mm from the limbus for 360 degrees (71%) or 180 degrees (29%). Multiple treatments were necessary in 13 eyes (46%). After CPC, IOP fell to 22 mm Hg or below in 18 eyes (64%) at 3 months, in 20 of 27 eyes (74%) at 6 months, and in 16 to 24 eyes (67%) at 1 year. Inadequate IOP control in four of 28 eyes necessitated cyclocryotherapy in three patients and a Schocket procedure in one other. Of the 14 clear pre-CPC grafts six (43%) became edematous during follow-up. All of the failed grafts had undergone multiple CPCs.
authors.affiliation: Cornea Service, Wills Eye Hospital, Philadelphia, PA 19107.
authors.forename: E J
authors.initials: EJ
authors.lastname: Cohen
authors.forename: L W
authors.initials: LW
authors.lastname: Schwartz
authors.forename: R D
authors.initials: RD
authors.lastname: Luskind
authors.forename: A V
authors.initials: AV
authors.lastname: Parker
authors.forename: G L
authors.initials: GL
authors.lastname: Spaeth
authors.forename: L J
authors.initials: LJ
authors.lastname: Katz
authors.forename: J J
authors.initials: JJ
authors.lastname: Arentsen
authors.forename: R P
authors.initials: RP
authors.lastname: Wilson
authors.forename: M D
authors.initials: MD
authors.lastname: Moster
authors.forename: P R
authors.initials: PR
authors.lastname: Laibson
mesh_terms: D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008028:Light Coagulation; D011182:Postoperative Care