Diode laser cyclophotocoagulation therapy efficacy in refractory glaucoma patients

Purpose: Diode laser cyclophotocoagulation is preferred when intraocular pressure can not be controlled with medical and sugical treatments in refractory glaucoma patients. In our study we aimed to reduce intraocular pressure and evaluate the success of diode laser cyclophotocoagulation in refractory glaucoma patients.Material and Method: Patients diagnosed with refractory glaucoma in our glaucoma clinic enrolled in this study between January 2008 and May 2011. Baseline examination before treatment included visual acuity, intraocular pressure with Goldmann applanation tonometry, slit-lamp examination, fundus examination, glaucoma type, number of medications, previous glaucoma surgeries. All patients underwent follow-up examinations at 1 day, 1 and 6 week, 3, 6 and 12 months after treatment.Results: Fifty-one patients treated but 49 of them completed 1 year follow up. Forty-nine eyes (25 right eyes, 24 left eyes) of 49 patients (18 female, 29 male) were included in the statistical analysis. Mean patient age was 61.4 ? 12.8 years (range 23?79 years). In the study group 25 patients (%51.2) had neovascular glaucoma, 9 patients (%18.4) had primary open angle glaucoma, 6 patients (%12.2) had primary angle closure glaucoma, 4 patients (%8.2) had pseudoexfoliation glaucoma, 5 patients (%10.2) had secondary glaucoma. Mean intraocular pressure was 44.1 ? 11.3 mmHg before treatment and reduced to 17.0 ? 9.8 mmHg at 1 year (%63.4) (p<0.05). Thirty-seven of the 49 eyes achieved intraocular pressure ? 22 mmHg (%75.5). Thirty-three of the 49 eyes achieved intraocular pressure reduction ? %30 from baseline levels (%87.8). Patients received maximum two treatment sessions. The mean power was 1851 mW (1500-2000), the mean duration was 1554 msn (600-2000), the mean application number was 20.9 (10-35). Patients received 59.7 ? 22.3 J energy. There was no statistical significance between delivered energy and final intraocular pressure. The mean number of antiglaucoma medications per eye dropped from 1.81 ? 0.92 to 1.30 ? 1.00 (p<0.05). In the study group 32 patients had no complications (%67.3), 7 patients had hypotony (%14.2), 5 patients had hyphema (%10.2), 3 patients had uveitis (%6.1), 2 patients had corneal epithelial defects (%4.0), 1 patient had bulluos keratopathy (%2.0), 1 patient had decreased visual acuity (%2.0).Conclusion: Diode laser cyclophotocoagulation is a safe and effective treatment modality for refractory glaucoma patients who have poor visual potential when intraocular pressure can not be controlled with medical and sugical treatments.Key Words: Glaucoma management, Intraocular pressure, Cyclodestruction, Diode laser cyclophotocoagulation