[Intraocular pressure results of contact transscleral cyclophotocoagulation with Neodymium YAG laser for refractory glaucoma].
OBJECTIVE
To evaluate the effects of contact transscleral cyclophotocoagulation with neodymium YAG laser for refractory glaucoma.


METHODS
This was a retrospective study with 36 patients (37 eyes) who were treated at the Rouen Hospital from February 1996 to February 2001. Patients had various types of glaucoma: glaucoma in pseudophakia (12), primary open-angle glaucoma (16), posttraumatic glaucoma (6), glaucoma associated with uveitis (4), neovascular glaucoma (3), and glaucoma after silicone oil (1). The Neodymium YAG laser (Alcon) was used for treatment. Energy was delivered in up 32 applications of 7-9 W for 0.7 seconds each. All patients except one 10-year-old child received retrobulbar anesthesia. Intraocular pressure was measured after 4 hours, 1 month, and 10 years.


RESULTS
The mean preoperative intraocular pressure of 30.3 (+/-1.3) mmHg decreased to 19.4 (+/-2) mmHg at 1 month and to 22.2 (+/-2.4) mmHg at 1 year. Seven patients underwent a second treatment during the year, since the first one was insufficient. Treatment lowered the number of medications used to decrease intraocular pressure from a pretherapy mean of 2.7 mmHg to 1.8 mmHg at 1 month and 2.07 mmHg at 1 year. In three patients who were treated for a painful sightless eye, the treatment failed.


CONCLUSIONS
Neodymium YAG laser necroses ciliary bodies. Treatment must be dosed to achieve the greatest efficacy without hypotonia, although hypotonia is rare, as is non-response to treatment. A few patients will be retreated during the year. The subgroup of sightless painful eyes had a high failure rate (75%), with half undergoing evisceration. We found no other differences according to the origins of refractory glaucoma.


CONCLUSIONS
Midterm results of contact transscleral cyclophotocoagulation with Neodymium YAG laser are encouraging in the treatment of refractory glaucoma.
Service d'Ophtalmologie, Hôpital Charles Nicolle, Rouen. qjc76@hotmail.com
J-C
JC
Quintyn
N
N
Grenard
M-F
MF
Hellot
D
D
Gruber
G
G
Brasseur
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology / Q000601:surgery*; D015355:Glaucoma, Neovascular / Q000601:surgery; D005902:Glaucoma, Open-Angle / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D017075:Laser Coagulation / Q000379:methods; D008297:Male; D008875:Middle Aged; D019591:Pseudophakia / Q000150:complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014605:Uveitis / Q000150:complications