Purpose: To evaluate the long-term outcome and complications of initial ciliary ablation with trans-scleral diode laser cyclophotocoagulation in the management of severe refractory glaucoma's.
Methods: We used diode laser to perform trans-scleral contact cyclophotocoagulationin 50 patients with medically and surgically uncontrollable glaucoma's and no previous ciliary ablation. Pre and postoperative information was registered and patients were followed for 6 months. We delivered laser energy through a 600 µm diameter quartz fiber probe especially designed for ciliary ablation (G-probe). About 17 to 19circumlimballaser applications (power 1500 -2000 m W, duration 2 sec) over 270o were given.
Results: The patients inclded 56% male and 44% females with a mean age of 49 years (12-94 years). Causes of refractory glaucoma in these patients were aphakic glaucoma (32%), absolute glaucoma (14%), post corneal graft (14%), congenital glaucoma (12%), neovascular glaucoma (8%), post corneoscleral laceration repair (8%), post deep vitrectomy (8%), ghost cell glaucoma (2%), and microphthalmia (2%). Twenty-eight percent had previous filtering surgery, 66% were aphakic, and 65% had ocular surgery other than glaucoma or cataract surgery. The mean preoperative IOP was 34.72± 6.48mmHg,andmean IOP six months after TSCPC was 20.80+12.79 mmHg, which shows 40% reduction (p= 0.001). The mean number of glaucoma medications decreased from 2.72 preoperatively to 1.27post operatively which showed 46% reduction (p= 0.001).
Conclusion: The results suggested that trans-scleral diode laser cyclophotocoagulation may be a useful procedure to reduce IOP and the number of medications needed in refractory glaucomas.