The Long-term Result of Diode Laser Transscleral Cyclophotocoagulation in the Management of Refractory Glaucoma after Intravitreal Silicone Oil Injection for Complicated Retinal Detachment

PURPOSE: To evaluate the long-term results of contact transscleral cyclophotocoagulation (TSCPC) in eyes with secondary glaucoma following intravitreal silicone oil injection. METHODS: Medical records of 18 eyes of 17 patients who underwent TSCPC following intravitreal silicone oil injection for complicated retinal detachment were reviewed. TSCPC was performed using diode laser at a power of 1.5 to 2.5 W, duration of 2 seconds, and with 14 to 27 applications. Intraocular pressure (IOP), number of glaucoma medications, status of anterior segment and retina, complications and visual acuity were evaluated. RESULTS: Overall mean number of treatments given per eye was 1.6. After a mean follow-up period of 122.7 (range, 49 to 228) weeks, the mean pretreatment IOP, 42.1+/-13.5 mmHg, decreased to 19.5+/-12.3 mmHg (p=0.001). The number of glaucoma medications was significantly decreased from 2.8+/-0.9 to 0.9+/-1.12 (p= 0.000). Hypotony or phthisis bulbi developed in one eye, respectively. Excluding the six eyes with no light perception before treatment, 4 (33.3%) of 12 eyes had stable or improved visual acuity at the final follow-up visit. Five of 8 eyes showing visual deterioration lost light perception. CONCLUSIONS: Medically uncontrolled glaucoma secondary to intravitreal silicone oil injection can be treated with TSCPC, although there is a significant risk of visual loss associated with the procedure.

Long-term Results of Diode Laser Trans-scleral Cyclophotocoagulation in Neovascular Glaucoma

To determine the long-term efficacy of diode laser trans-scleral cyclophotocoagulation in neovascular glaucoma, a retrospective analysis was done in 30 patients(32 eyes) with intractable neovascular glaucoma treated with diode laser trans-scleral cyclophotocoagulation between March 1996 and June 1997, by reviewing the treatment parameters, complications, and preand postoperative intraocular perssure(IOP). The IOP was compared using a Wilcoxon signed rank test, and the success rate was evaluated by a Kaplan-Meier life-table analysis. Success was defined as an IOP of 21mmHg or lower in the absence of phthisis without any additional surgical procedure. The mean follow-up was 54.6+/-13.3 weeks. The mean preoperative IOP was 46.2+/-9.6mmHg. The mean postoperative IOP was 10.5+/-8.7mmHg(p=0.000). The mean number of preoperative medications was 2.2+/-0.6. The mean number of postoperative medications was 0.5+/-0.9(p=0.000). Kaplan-Meier survival analysis showed a probability of continued success at 44 weeks and 60 weeks to be 80.2% and 44.5%, each, without any antiglaucoma medications and 86.4% and 66.1%, each, with some antiglaucoma medications. Complications included phthisis(12.5%), hypotony(9.0%), and hyphema(25%). This study suggests that diode laser trans-scleral cyclophotocoagualtion provides a significant long-term reduction of intraocular pressure in eyes with intractable neovascular glaucoma.