Cyclophotocoagulation with the transscleral contact red 670-nm diode laser in the treatment of glaucoma.

PURPOSE: To retrospectively evaluate the results of cyclophotocoagulation (CPC) with the transscleral contact red 670-nm diode laser in treating glaucoma. METHODS: Cyclophotocoagulation was performed in 60 eyes of 60 patients with a mean age of 74 +/- 11 years (range 49-90 years). The treatment was delivered via a fibre-optic probe. The power per application was 430 mW. Exposure time was 10 seconds. RESULTS: The mean overall follow-up time after the initial CPC was 26 +/- 20 months (range 3-75 months). Preoperative intraocular pressure (IOP) was 27 +/- 11 mmHg (n = 60). After one or more CPC treatments, mean IOP decreased to 20 +/- 7 mmHg (n = 51) at 1 month, 19 +/- 5 mmHg (n = 45) at 3 months, 18 +/- 5 mmHg (n = 29) at 6 months, 19 +/- 7 mmHg (n = 22) at 1 year, 18 +/- 7 mmHg (n = 16) at 2 years, 14 +/- 4 mmHg (n = 8) at 3 years, and 18 +/- 6 mmHg (n = 60) at the last follow-up. An IOP of 8-21 mmHg or a > 30% decrease in IOP was obtained in 33 of 41 eyes (80%) with baseline IOP > 21 mmHg at the last follow-up. Hypotonia (IOP < 8 mmHg) did not develop in any of the eyes studied. CONCLUSIONS: Cyclophotocoagulation with the red 670-nm diode laser is an effective and well tolerated means of treating glaucoma.

Transscleral red-laser cyclophotocoagulation combined with limited anterior retinal cryocoagulation in neovascular glaucoma.

PURPOSE: To evaluate transscleral contact red-laser cyclophotocoagulation (CPC), using a visible red 647-nm krypton or 670-nm diode laser and limited transscleral anterior retinal cryocoagulation in neovascular glaucoma. METHODS: In a retrospective case series, 35 eyes of 35 consecutive patients treated during a period of 6 years were included in the study. Inclusion was dependent on follow-up of at least 1 month. Patients who had undergone previous cyclodestructive procedures and patients who received an additional glaucoma operation in conjunction with CPC were excluded. In the combined procedure, the power per CPC application was 370-450 mW and exposure time was 10 seconds. One to two rows of cryoapplications were given to 360 degrees of the anterior retina. RESULTS: The success rate in terms of intraocular pressure (IOP of 8-21 mmHg or a decrease in IOP > 30%) was 89% at the last follow-up (17 +/- 15 months). Iris neovascularization regressed in 51% of eyes. Hypotonia developed in one (3%) eye (IOP of 5 mmHg). No cases of phthisis bulbi were seen. Visual acuity (VA) declined in 49% of eyes. CONCLUSIONS: A combination of transscleral contact red-laser CPC with limited anterior retinal cryocoagulation is efficient in lowering IOP in neovascular glaucoma and is well tolerated. During follow-up, a decrease in VA occurs in a significant proportion of patients.

Corneal innervation, corneal mechanical sensitivity, and tear fluid secretion after transscleral contact 670-nm diode laser cyclophotocoagulation.

PURPOSE: To examine the effect of 670-nm diode laser cyclophotocoagulation on corneal morphology, density of corneal subbasal nerves, corneal mechanical sensitivity, and the rate of tear fluid secretion in human eyes. PATIENTS AND METHODS: Transscleral contact cyclophotocoagulation was performed in 10 eyes of 10 consecutive patients on 180 degrees of the pars plicata of the ciliary body, using a 670-nm diode laser (power = 430 mW, application time = 10 seconds). In vivo confocal microscopy, with special attention to corneal morphology and the density of the subbasal nerves in the central and inferior perilimbal cornea, was performed preoperatively, and at 3 days and 1 month postoperatively. Corneal mechanical sensitivity was tested preoperatively, and at 3 days and 1 month postoperatively, using a Cochet-Bonnet esthesiometer. The rate of tear fluid secretion was measured preoperatively and 1 month postoperatively, using the Schirmer basic secretion tear test with topical anesthesia. RESULTS: After cyclophotocoagulation, in vivo confocal microscopy did not reveal any changes in any of the corneal layers or in the corneal subbasal nerves. After treatment, as compared with baseline (paired samples test, > 0.05), there was no statistically significant change in the mechanical sensitivity values in any part of the cornea or in the Schirmer basic secretion tear test result. CONCLUSION: The results of this preliminary study suggest that cyclophotocoagulation with the 670-nm diode laser does not impair corneal innervation.