Long-term results of transscleral Nd:YAG cyclophotocoagulation for refractory glaucoma postpenetrating keratoplasty.
OBJECTIVE
To determine the effects of noncontact transscleral Nd:YAG cyclophotocoagulation (NCTY) in the treatment of refractory glaucoma postpenetrating keratoplasty (PKP) with respect to intraocular pressure (IOP), corneal graft survival, and reduction of glaucoma medications.


METHODS
The records of all patients treated with NCTY for refractory glaucoma after PKP at the authors' institution over an 11-year interval were reviewed. The LASAG noncontact Nd:YAG laser (Lasag AG; Thun, Switzerland) was used. Approximately 40 laser applications were delivered per eye. Visual acuity, IOP, glaucoma medications, and corneal graft clarity were evaluated.


RESULTS
Fifty-two eyes met the inclusion criterion. The mean pretreatment IOP was 38.7+/-11.9 mm Hg. The mean posttreatment IOP was 15.8+/-9.7 mm Hg. From life table analysis, the probability of having a posttreatment IOP of 21 mm Hg or less with or without medication was 70% at 1 year and 63% at 5 years. The probability of a graft remaining clear was 79% at 1 year and 56% at 5 years. In 85% of patients the visual acuity remained stable, in 11% the visual acuity improved, and in 4% the visual acuity deteriorated after treatment. One patient developed hypotony. Twenty patients (36.5%) were able to discontinue one or more glaucoma medications posttreatment.


CONCLUSIONS
In this group of patients with PKP glaucoma, NCTY effectively lowered IOP over the long term, with 36.5% of patients discontinuing one or more glaucoma medications. There was, however, a significant incidence of graft failure at 5 years.
Beiran
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Department of Ophthalmology, University Health Network, University of Toronto, Ontario, Canada.
Rootman
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Trope
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Buys
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002924:Ciliary Body / Q000601:surgery*; D003315:Cornea / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D012590:Sclera; D016896:Treatment Outcome; D014792:Visual Acuity