title: Supplemental transscleral diode laser cyclophotocoagulation after aqueous shunt placement in refractory glaucoma.
abstract: OBJECTIVE
  To assess the outcome of supplemental transscleral diode laser cyclophotocoagulation after aqueous tube shunt placement to obtain effective intraocular pressure (IOP) control.
  
  
  METHODS
  Retrospective non-comparative case series.
  
  
  METHODS
  Twenty-one eyes in 21 subjects with uncontrolled IOP despite the presence of an aqueous tube shunt and maximally tolerated glaucoma medications.
  
  
  METHODS
  Supplemental transscleral diode laser cyclophotocoagulation was performed.
  
  
  METHODS
  Reduction of intraocular pressure and reduction of glaucoma medications.
  
  
  RESULTS
  Twelve adults and nine children underwent supplemental transscleral diode cyclophotocoagulation and were followed postoperatively for a mean of 26.9 +/- 13.4 (standard deviation [SD]) months (range, 7-58 months). Average IOP was significantly reduced from a preoperative level of 35.7 +/- 14.7 (SD) mmHg to a postoperative level of 13.6 +/- 7.1 (SD) mmHg (P < 0.001) with the mean number of medications significantly reduced to 1.5 +/- 1.3 (SD) (P < 0.001). Seven subjects (33%) had additional laser treatment to achieve IOP control. Six subjects who were therapy failures included three who developed no light perception in the setting of proliferative diabetic retinopathy, one subject with chronic angle-closure glaucoma who gradually developed no light perception after refusing further treatment or medication, and two subjects who developed retinal detachments. One child who was a qualified success underwent enucleation and debulking of an enlarging neurofibroma that caused significant proptosis and disfigurement.
  
  
  CONCLUSIONS
  In cases of glaucoma that are uncontrolled despite a glaucoma aqueous tube shunt and multiple medications, adjunctive transscleral diode cyclophotocoagulation treatment(s) is a viable option to lower IOP.
authors.affiliation: The Department of Ophthalmology and Visual Sciences, Vanderbilt University, Nashville, Tennessee 37232-8808, USA..
authors.forename: Terry M
authors.initials: TM
authors.lastname: Semchyshyn
authors.forename: James C
authors.initials: JC
authors.lastname: Tsai
authors.forename: Karen M
authors.initials: KM
authors.lastname: Joos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001082:Aqueous Humor / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D002924:Ciliary Body / Q000601:surgery*; D005260:Female; D005901:Glaucoma / Q000378:metabolism / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012086:Reoperation; D012189:Retrospective Studies; D012590:Sclera; D017211:Treatment Failure; D016896:Treatment Outcome