Diode laser cycloablation in adult glaucoma: long-term results of a standard protocol and review of current literature.
BACKGROUND
To study the long-term efficacy and safety of diode laser cycloablation under a standard protocol in refractory glaucoma.


METHODS
A retrospective study involving 42 eyes (39 patients), observed for 36-84 (mean 65.7) months after cycloablation involving 14 burns of 2-W power and 2-s duration, over 270 degrees of the ciliary body.


RESULTS
By final review, mean intraocular pressure (IOP) had dropped by 50.3% from 31.4 +/- 8.8 mmHg before treatment to 15.6 +/- 6.3 mmHg (P < 0.0001). Thirty-seven of the 42 eyes (88.1%) achieved IOP < 22 mmHg. Thirty-five of the 42 eyes (83.3%) eyes achieved IOP reduction > or = 30% from baseline levels. The mean number of antiglaucoma medications per eye dropped from 2.55 +/- 0.83 to 1.71 +/- 1.44 (P = 0.0004). The percentage of eyes requiring oral acetazolamide dropped from 92.9% to 11.9% (P < 0.0001). About 59.6% of eyes required multiple treatment sessions (mean 2.17). Twenty-seven (64.3%) eyes suffered deterioration, 11 (26.2%) maintained stability and 4 (9.5%) exhibited improvement of visual acuity. No relationship between the number of treatment sessions and visual outcome was evident.


CONCLUSIONS
This conservative repeatable protocol affords delivery of the minimum dose of photocoagulation necessary to achieve a safe, long-term ocular hypotensive response, while minimizing the risk of serious adverse effects, and is valuable in the difficult treatment of refractory glaucoma.
Vernon
Stephen A
SA
Directorate of Ophthalmology, Queens Medical Centre, Nottingham, UK. stephen.vernon@nuh.nhs.uk
Koppens
Joanne M
JM
Menon
G Jayakrishna
GJ
Negi
Anil K
AK
D000086:Acetazolamide / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use; D002924:Ciliary Body / Q000601:surgery*; D004363:Drug Utilization; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide