Long-Term Follow-Up after Transscleral Diode Laser Photocoagulation in Refractory Glaucoma

BACKGROUND AND OBJECTIVE: Patients affected by glaucoma refractory to medical or surgical treatment are difficult to treat. The aim of this study was to evaluate the long-term effect of contact transscleral diode laser cyclophotocoagulation (DLPC) on intraocular pressure (IOP) and on visual acuity of these patients. PATIENTS AND METHODS: One hundred and twenty eyes of 107 patients suffering from refractory glaucoma and treated with DLPC were followed at the Eye Clinic of Verona University for an average of 26 +/- 8 months. Mean age was 57 +/- 26 years. IOP, visual acuity, and ocular complications were analyzed. RESULTS: A total of 207 treatments were given. More than one treatment was given in 55 eyes (45.8%). Mean pretreatment IOP was 30.4 +/- 3.1 mm Hg. At the last follow-up, mean IOP was 20.3 +/- 1.8 mm Hg. Mean total medications were reduced from 4.5 +/- 0.5 to 2.3 +/- 0.3. No serious complications occurred in the 207 treatments. Visual acuity remained stable in 66 eyes (55%), improved in 25 eyes (20.8%), and decreased in 29 eyes (24.2%). CONCLUSIONS: DLPC was effective in lowering IOP in eyes with refractory glaucoma. It also served to reduce the number of antiglaucoma medications, thus improving both the quality of life of the patients and their compliance to therapy. This procedure is relatively safe, very fast and easy to learn. However, careful attention is required to determine the exact position of the ciliary body in malformative glaucoma. Multiple treatments may be required to control IOP.