Long-term results of transscleral cyclophotocoagulation in refractory pediatric glaucoma patients

We evaluated efficacy and complications of diode laser cyclophotocoagulation in pediatric patients with refractory glaucomas. The retrospective study comprised 69 eyes of 53 pediatric patients with uncontrolled refractory glaucoma treated by transscleral diode laser cyclophotocoagulation. The mean age was 6.1 +/- 4.29 (range 0.9-15) years. The main parameters evaluated were: intraocular pressure (IOP), visual acuity, and complications. The mean follow-up period was 5.6 +/- 2.8 (range 2.2-9.5) years. Treatment success was defined as a postoperative IOP of 相似文献   

Diode laser cyclophotocoagulation in refractory glaucoma: comparison between pediatric and adult glaucomas

OBJECTIVE: To evaluate the outcome of contact transscleral diode laser cyclophotocoagulation (CTDC) in eyes with advanced glaucoma and to compare the efficacy in pediatric and adult patients. PATIENTS AND METHODS: Included in the study were 41 eyes (39 patients) with advanced glaucoma (15 eyes of 13 pediatric patients and 26 eyes of 26 adult patients). The patients were followed at least for six months or until failure of the procedure, if shorter than 6 months. The mean follow-up of all patients was 10 months (median 8 months, range 3-24 months); the mean pretreatment intraocular pressure (IOP) was 34.5+/-10.9 mm Hg for all cases, 36.2+/-12.6 mm Hg in adult cases and 31.6+/-6.5 mm Hg in pediatric cases. RESULTS: At last follow-up after first treatment, there was significant decrease in IOP and the mean reduction in IOP was 12.11+/-10.5 mm Hg for all eyes. The mean reduction in IOP adult (13.6+/-11.8 mm Hg) and (9.9+/-6.8 mm Hg) patients. While the success rate after the first diode laser therapy was 59%, it increased to 75% after retreatments. The most common complications were conjunctival hyperemia and anterior chamber reaction. There was no difference in the complication rate between the pediatric and adult cases. CONCLUSION: CTDC is a safe and effective therapy in eyes with advanced refractory glaucoma in the short term. But multiple applications may be needed in the long term. The results in adult and pediatric patients were found to be similar in efficacy and safety.     

A two centre study of the dose-response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma

BACKGROUND/AIMS: Transscleral diode laser cyclophotocoagulation ("cyclodiode") is widely used to treat refractory glaucoma. The main aims of this study were to investigate the dose-response relation of cyclodiode and to evaluate possible predictive factors that would help establish optimum treatment parameters. METHODS: A retrospective analysis of the case notes of 263 eyes of 238 consecutive patients who underwent transscleral diode laser cyclophotocoagulation at two centres was undertaken. RESULTS: Mean intraocular pressure (IOP) decreased significantly from 40.7 mm Hg (SD 13.7) before cyclodiode therapy to 17.7 mm Hg (SD 10.9) post-treatment, a reduction of 52.6% (p = 0.0001). Following cyclodiode, 89% of patients achieved an IOP of less than 22 mm Hg or a greater than 30% drop in IOP. Hypotony occurred in 9.5% of patients, 76% of whom had neovascular glaucoma. A linear dose relation response was found for the 122 eyes with neovascular glaucoma (p = 0.001) but not for the group as a whole. Treatment failure was associated with male sex (multivariate regression analysis, p = 0.008) and low mean energy per treatment session (univariate analysis alone, p = 0.016). High pretreatment IOP (p = 0.031) and high mean energy per treatment episode (p = 0.001) appeared to be associated with the occurrence of hypotony, although multivariate analysis did not support this finding. CONCLUSION: Cyclodiode therapy is highly effective but there is a significant risk of hypotony, which may be reduced by applying lower energy in cases of very high pretreatment IOP and in neovascular glaucoma. The dose-response association remains unpredictable, although a linear relation was found for neovascular glaucoma.     

"Cyclodiode": results of a standard protocol.

AIMS: To analyse the results of intraocular pressure (IOP) reduction in refractory glaucoma following diode laser cyclophotocoagulation with a repeatable standard protocol. METHODS: 58 eyes of 53 patients were followed for 6-37 months (mean 19 months) after initial cyclodiode treatment. RESULTS: Mean (SD) pretreatment IOP for the 58 eyes was 33.0 mm Hg (10.7) reducing at final index visit to 16.7 mm Hg (7.8) (p < 0.0001). The mean antiglaucoma medication score per eye was significantly reduced from 2.4 (0.8) to 1.4 (1.0) at last index visit (p < 0.0001) with 91% of patients able to stop oral acetazolamide. 45% of eyes required more than one treatment and the overall mean per eye was 1.6 (range 1-5). Of eyes with visual acuity 6/60 or better pretreatment, 12 (32%) lost more than two lines of Snellen acuity and two eyes with poorer acuity initially dropped to NPL. Poor visual outcome was associated with the presence of diabetic retinopathy. Hypotony (IOP < 5 mm Hg) was noted in two eyes at the last index visit although neither had specific signs of the same. No phthisis was seen. CONCLUSION: The simple treatment protocol, repeated if necessary, appears relatively safe and effective at lowering IOP in eyes with refractory glaucoma.     

Diode laser transscleral cyclophotocoagulation for refractory glaucoma

PURPOSE: To evaluate the efficacy of contact diode laser transscleral cyclophotocoagulation using different treatment parameters. METHODS: All eyes undergoing contact diode laser transscleral cyclophotocoagulation between April 1991 and September 1997 at our two institutions were enrolled. Success was defined as an intraocular pressure less than or equal to 22 mm Hg or absence of pain for poorly sighted and blind eyes. RESULTS: Two hundred six eyes of 204 patients (Salzburg, 117 eyes; New York, 89 eyes) were enrolled. Mean patient age was 65.8 +/- 18.7 years (range, 4-96 years). Mean follow-up was 9.2 +/- 11.2 months (range, 3-56 months). Mean preoperative and postoperative IOPs were 42.1 +/- 11.0 mm Hg (range, 24-76 mm Hg) and 17.3 +/- 10.9 mm Hg (P < 0.001) and 20.3 +/- 13.2 mm Hg (P < 0.001) at 12 and 24 months, respectively. The number of laser applications (mean, 18.6 +/- 4.2; range, 10-40) and maximal laser power (mean, 2,352 +/- 408.5 mW; range, 1,500-3,000) were not associated with a lower postoperative IOP. An IOP less than or equal to 22 mm Hg was achieved in 72.7% of eyes at the mean follow-up of 9 months. Thirty-three (16.0%) eyes required at least one retreatment. Phthisis occurred in four (1.9%) eyes. CONCLUSION: Contact diode laser transscleral cyclophotocoagulation is useful in eyes with refractory glaucoma in which the risks of outflow surgery are deemed unacceptable.     

眼内窥镜下睫状体光凝对角膜植片存活的影响

目的探讨对穿透性角膜移植术（PKP）后眼压升高且药物不能控制的患者,采用眼内窥镜直视下睫状体光凝术（ECP）进行治疗的疗效和对角膜植片存活的影响。方法选择2000年3月至2004年4月期间,于中山大学中山眼科中心就诊的34例（34只眼）PKP术后眼压升高且药物不能控制患者,在眼内窥镜直视下,行半导体激光睫状体光凝术（12例）或联合玻璃体切除术（22例）（ECP组）。选择26例（26只眼）患者作为对照,采用经巩膜面半导体激光睫状体光凝术（TCP）（TCP组）。术前、术后随访观察视力、眼压、植片透明度、内皮细胞密度及前房反应,超声活体显微镜（UBM）检查睫状突和房角情况,注意术后并发症等。结果ECP组术后3个月和6个月时,分别有13例（38．2％）和23例（67．7％）眼压低于21mmHg。TCP组术后3个月和6个月时,分别有10例（38．5％）和8例（30．8％）眼压低于21mmHg。两组之间术后眼压控制率比较,在3个月时差异无统计学意义（X^2=0．0003,P=0．986）,但6个月时差异有统计学意义（X^2=8．024,P=0．005）。ECP组和TCP组术后植片内皮细胞密度分别为（1013±170）个／mm^2和（847±136）个/mm^2,差异有统计学意义（t=-0．009,P=0．033）。ECP组和TCP组术后分别有9例（26．5％）和21例（80．8％）出现反应性虹膜炎,两组之间比较差异有统计学意义（x^2=17．376,P=0．001）。结论ECP对降低PKP术后青光眼患者眼压的远期疗效优于TCP。ECP对角膜植片内皮细胞的损伤和引起术后葡萄膜炎的程度均较TCP轻,相对提高了PKP术后角膜植片的生存质量。     

Transscleral diode laser photocoagulation in refractory glaucoma

BACKGROUND AND OBJECTIVE: Patients with glaucoma refractory to medical or surgical treatment are difficult to treat. The aim of this study was to evaluate the effect of contact transscleral diode laser cyclophotocoagulation (DLPC) on these patients' intra-ocular pressure (IOP) and visual acuity. PATIENTS AND METHODS: 37 eyes of 36 patients who suffered from refractory glaucoma and who had undergone DLPC, were followed at the Eye Clinic of Verona University for an average of 14 +/- 4 months. The average age was 54 +/- 26 years. IOP, visual acuity and ocular complications were analysed. RESULTS: A total of 71 treatments were given. More than 1 treatment was given in 22 eyes (59%). The mean pretreatment IOP was 33.1 +/- 3.3 mm Hg. At the last follow-up, the mean IOP was 21 +/- 1.6 mm Hg. Mean total medications were reduced from 4.4 +/- 0.5 to 2.4 +/- 0.3. No serious complications occurred in 71 treatments. Visual acuity remained stable in 25 eyes (67.5%), improved in 6 eyes (16.2%) and decreased in 6 eyes (16.2%). CONCLUSIONS: DLPC is effective in lowering IOP in eyes with refractory glaucoma. It also serves to reduce the number of antiglaucoma medications. This procedure is relatively safe. Nevertheless, multiple DLPC applications may be needed.     

Longterm follow‐up of diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma

Purpose: This prospective study was conducted to evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TDLCP) in advanced refractory glaucoma. Methods: A total of 124 eyes in 121 patients with advanced glaucoma refractory to medical treatment were treated consecutively with TDLCP. Success was defined as final intraocular pressure (IOP) of 5?21 mmHg in eyes with visual acuity (VA) of more than hand movements (HM) and relief of pain in eyes with VA of HM or less, including blind eyes. Results: Mean patient age was 65.6 ± 17.1 years (range 14–91 years). Mean follow‐up was 17 ± 14.6 months (range 3–42 months). Mean pretreatment IOP was 29.9 ± 8.4 mmHg (range 17–58 mmHg) and IOP at last follow‐up was 20.8 ± 8 mmHg (range 6–45 mmHg) (p < 0.001). The number of laser applications (mean 9.2 ± 2.8, range 4–15) and maximal laser power (mean 2.01 ± 0.22 mW, range 1.3–3.0 mW) were not associated with lower postoperative IOP. Intraocular pressure of ≤ 21 mmHg was recorded in 63.0% of eyes at the last follow‐up visit. Overall, 28 (21.7%) eyes required at least one retreatment. No phthisis bulbi or persistent hypotonia developed. Conclusions: TDLCP is an effective and safe method for the treatment of advanced refractory glaucoma, although repeated treatments are often necessary.     

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.     

Transillumination guided cyclocryotherapy in the treatment of secondary glaucoma.

A consecutive series of 38 eyes of 35 glaucoma patients treated with transillumination guided cyclocryotherapy (CCT) either to obtain pain relief or to achieve IOP control was studied at Helsinki University Eye Hospital. Transillumination was used to guide the applications to the correct site. The follow-up range was 1-43 months (mean 9 months). Pretreatment IOP was 39 +/- 13 mm Hg and postoperative 26 +/- 16 mm Hg (mean +/- SD). Twenty-three eyes underwent one and 15 eyes 2-5 procedures. IOP control (IOP 9-23 mm Hg) was achieved in 50%. The response was more favorable in eyes without iris neovascularisation (59% achieved IOP control) than in eyes with neovascular glaucoma (38% achieved IOP control). The best response was achieved in eyes with chronic uveitis (5/7 eyes achieved IOP control). Repeated procedures improved the IOP control rate. Hypotony (IOP < 9 mm Hg) without clinical signs of phthisis occurred in three eyes (8%). Thirteen eyes needed primarily pain relief and 92% achieved it. Postoperatively vision was better in 8%, unchanged in 37% and worse in 55%. Visual acuity was 0.05 or better in nine eyes pretreatment and in eight eyes after treatment.     

Contact diode laser transscleral cyclophotocoagulation for refractory glaucoma: comparison of two treatment protocols

BACKGROUND: Diode laser transscleral cyclophotocoagulation has shown promising results in the treatment of refractory glaucoma. Treatment with a lower energy level per pulse and lower total energy is safer but may be less effective.We performed a study to evaluate the clinical effectiveness and safety of contact transscleral cyclophotocoagulation using two different protocols in the treatment of Chinese patients with refractory glaucoma. METHODS: Review of the records of 129 patients with refractory glaucoma who underwent contact transscleral cyclophotocoagulation for the first time performed by two different surgeons. In group 1 (73 eyes) the output was 2.5 W and the exposure time 2 seconds; in group 2 (56 eyes) the corresponding values were 2.0 W and 1.5 seconds. We recorded the number of antiglaucoma medications used, Snellen visual acuity, slit-lamp biomicroscopic findings, intraocular pressure (IOP) and findings on ophthalmoscopy with pupil dilation before and 1 day, 1 week, 1 month, 3 months and 6 months after treatment. RESULTS: The mean age of the patients was 56.4 years (standard deviation [SD] 18.3 years) in group 1 and 53.5 (SD 18.0) years in group 2. The most frequent diagnoses were neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, and glaucoma associated with penetrating keratoplasty. The mean number of laser pulse applications per patient was 27 (SD 5.1) (range 10-36) in group 1 and 55 (SD 6.1) (range 40-60) in group 2. One month after treatment, the mean reduction in IOP was 20.2 mm Hg (SD 14.2 mm Hg) in group 1 and 13.7 mm Hg (SD 15.8 mm Hg) in group 2, a significant difference (p = 0.035). There was no difference between the two groups in the mean reduction in IOP at 6 months (19.1 mm Hg [SD 15.1 mm Hg] vs. 14.2 mm Hg [SD 16.3 mm Hg]).The mean reduction in the number of antiglaucoma medications was 1.2 (SD 1.1) in group 1 and 0.6 (SD 1.0) in group 2 (p = 0.003). The incidence rates of transient hyphema in the anterior chamber (23.3% vs. 7.1%) and of transient exudate in the anterior chamber (8.2% vs. 0.0%) were significantly higher in group 1 than in group 2 (p < 0.005). INTERPRETATION: To achieve greater IOP reduction with diode laser transscleral cyclophotocoagulation, an increase in energy per pulse may be more effective than an increase in total applications.     

Diode laser transscleral cyclophotocoagulation in the treatment of chronic angle-closure glaucoma: a preliminary study

PURPOSE: To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation in the treatment of chronic angle-closure glaucoma. PATIENTS AND METHODS: A prospective, non-comparative interventional pilot study was conducted. Fourteen eyes of 14 Chinese patients with chronic angle-closure glaucoma whose intraocular pressures were greater than 21 mm Hg on medications were treated with diode laser transscleral cyclophotocoagulation using the G-probe at the United Christian Hospital between February 2000 and May 2001. The inferior 270 degrees quadrant (from 2 to 11 o'clock for right eye and from 1 to 10 o'clock for left eye) was treated and the patients were followed up regularly. The initial laser energy was set at 2,000 mWatt with a duration of 2 seconds. The post-treatment anti-glaucoma medications were adjusted according to the intraocular pressure. If medications failed to lower the intraocular pressure to below 21 mm Hg, cyclophotocoagulation to the same inferior 270 degrees quadrant was repeated. RESULTS: All patients completed a 12-month follow-up period. The total success rate defined as IOP < 21 mm Hg with or without medication(s) was 85.7% at 1 year of follow-up review. The mean +/- SD intraocular pressure decreased from pre-treatment level of 36.9 +/- 11.7 mm Hg to 18.9 +/- 6.5 mm Hg at 1 year after treatment. The difference was statistically significant (P < 0.001) (Paired t test). The mean +/- SD number of IOP-lowering eyedrops was significantly reduced from 1.9 +/- 0.7 before cyclophotocoagulation to 0.4 +/- 0.8 at 1 year after treatment (P = 0.0002) (Paired t test). Two eyes required repeat treatment. Seven eyes (50%) had atonic pupil following the laser treatment. CONCLUSION: Diode laser transscleral cyclophotocoagulation is effective in lowering the intraocular pressure in chronic angle-closure glaucoma and its effect lasts for at least 1 year.     

Intermediate-term results of endoscopic diode laser cyclophotocoagulation for pediatric glaucoma.

INTRODUCTION: Endoscopic diode laser cyclophotocoagulation (EDLC) is a new treatment modality for glaucoma. Experience with this surgical procedure in children is limited. We report our results after 3 years of follow-up and review the safety of this procedure in pediatric patients. METHODS: EDLC was performed on 10 eyes of 8 children who had either aphakic glaucoma or refractory congenital glaucoma. Patients were treated in 2 groups. An initial group of 5 eyes with poor visual prognosis underwent a conservative treatment of no more than 180 degrees of ciliary processes. After an observational period, a second group of 5 eyes with better visual potential was treated more aggressively. Most eyes in the second group received cyclophotoablation to 270 degrees of ciliary processes. Patients were followed up until time of failure or for a minimum of 3 years. RESULTS: At 3 years of follow-up, 50% of eyes that received a single treatment of endolaser had an intraocular pressure (IOP) of < or =22 mm Hg with or without glaucoma medications. Twenty percent had an IOP < or =22 mm Hg without any glaucoma medications. Five eyes were treated successfully with a mean IOP of 17.8 +/- 3.4 mm Hg at 36 months of follow-up. The remaining 5 eyes were considered treatment failures with postoperative IOPs >22 mm Hg, despite adjunctive glaucoma medications. Mean time to treatment failure was 10.5 months (range, 3.7-22.2 months). No sight-threatening complications occurred. None of the eyes became hypotonus or caused undue discomfort during the postoperative period. CONCLUSION: EDLC is a relatively safe and effective procedure for the management of difficult pediatric glaucoma. Results are comparable to other cyclodestructive modalities. Although not observed in this study, it should be cautioned that phakic eyes might be at increased risk for surgical complications.     

Translimbal laser photocoagulation to the trabecular meshwork as a model of glaucoma in rats

PURPOSE: To develop and characterize a model of pressure-induced optic neuropathy in rats. METHODS: Experimental glaucoma was induced unilaterally in 174 Wistar rats, using a diode laser with wavelength of 532 nm aimed at the trabecular meshwork and episcleral veins (combination treatment group) or only at the trabecular meshwork (trabecular group) through the external limbus. Intraocular pressure (IOP) was measured by a tonometer in rats under ketamine-xylazine anesthesia. Possible retinal vascular compromise was evaluated by repeated fundus examinations and by histology. The degree of retinal ganglion cell (RGC) loss was assessed by a masked, semiautomated counting of optic nerve axons. Effects of laser treatment on anterior ocular structures and retina were judged by light microscopy. RESULTS: After the laser treatment, IOP was increased in all eyes to higher than the normal mean IOP of 19.4 +/- 2.1 mm Hg (270 eyes). Peak IOP was 49.0 +/- 6.1 mm Hg (n = 108) in the combination group that was treated by a laser setting of 0.7 seconds and 0.4 W and 34.0 +/- 5.7 mm Hg (n = 46) in the trabecular group. Mean IOP after 6 weeks was 25.5 +/- 2.9 mm Hg in glaucomatous eyes in the combination group compared with 22.0 +/- 1.8 mm Hg in the trabecular group. IOP in the glaucomatous eyes was typically higher than in the control eyes for at least 3 weeks. In the combination group, RGC loss was 16.1% +/- 14.4% at 1 week (n = 8, P = 0.01), 59.7% +/- 25.7% at 6 weeks (n = 88, P < 0.001), and 70.9% +/- 23.6% at 9 weeks (n = 12, P < 0.001). The trabecular group had mean axonal loss of 19.1% +/- 14.0% at 3 weeks (n = 9, P = 0.004) and 24.3% +/- 20.2% at 6 weeks (n = 25, P < 0.001), increasing to 48.4% +/- 32.8% at 9 weeks (n = 12, P < 0.001). Laser treatment led to closure of intertrabecular spaces and the major outflow channel. The retina and choroid were normal by ophthalmoscopy at all times after treatment. Light microscopic examination showed only loss of RGCs and their nerve fibers. CONCLUSIONS: Increased IOP caused by a laser injury to the trabecular meshwork represents a useful and efficient model of experimental glaucoma in rats.     

Influence of total energy delivery on success rate after contact diode laser transscleral cyclophotocoagulation: a retrospective case review and meta-analysis

PURPOSE: To evaluate the effect of a single treatment of contact diode laser transscleral cyclophotocoagulation (TSCP) on intraocular pressure (IOP) in patients with refractory glaucoma and perform a historical meta-analysis of the relationship between successful IOP control and various laser parameters. METHODS: Clinical data for 47 eyes of 43 patients who underwent a single session of contact diode laser TSCP (power of 2000 mW, exposure time of 2 seconds and 25.6 average applications) for refractory glaucoma at Pasco Eye Institute between 1996 and 2001 were reviewed. Baseline IOP was compared with the postoperative IOP at 1 month, 3 to 6 months, and 1 year. Snellen visual acuity and the number of glaucoma medications being used 3 to 6 months postoperatively were compared with baseline. Complications were also evaluated. The relationship between successful IOP control and various laser parameters (energy applied per eye, energy per laser application, power, exposure time and number of laser applications) was examined using the results of this study and previous investigations. RESULTS: The mean +/- standard deviation (SD) baseline IOP was 29.4 +/- 10.9 mm Hg. Diode laser TSCP decreased average IOP to 15.7 +/- 12.0 mm Hg at 1 month, 16.3 +/- 4.2 mm Hg at 3 to 6 months, and 16.2 +/- 4.8 mm Hg at 1 year, postoperatively. This represents an IOP reduction of approximately 45%. The percentage of patients maintaining a postoperative IOP of <21 mm Hg was 95.7% at 1 month, 92.1% at 3 to 6 months, and 94.4% at 1 year after TSCP. At the 3 to 6 month postoperative visit, the average +/- SD change in Snellen visual acuity (-0.5 +/- 1.1 lines) and the number of glaucoma medications used did not differ significantly from baseline. Combined analysis of the results of this study and previous studies reveals a linear, direct correlation (r = 0.91) between the percentage of patients achieving a successful outcome (defined as a final IOP < 21 or 22 mm Hg) and the total energy delivered to the ciliary body during the treatment session. CONCLUSIONS: Diode laser TSCP is a safe and highly effective method for lowering IOP in patients with uncontrolled glaucoma. Higher total energy levels in a given treatment session appear to be associated with increased success as defined by the percentage of patients achieving an IOP < 21 or 22 mm Hg, without an increased risk of additional complications or vision loss.     

Intraocular pressure response to selective laser trabeculoplasty in the treatment of primary open-angle glaucoma

PURPOSE: To evaluate the intraocular pressure (IOP) response to selective laser trabeculoplasty (SLT) in the treatment of uncontrolled primary open-angle glaucoma (POAG) in a prospective clinical study. SLT is a new laser procedure that selectively targets trabecular meshwork (TM) cells without coagulative damage to the TM. METHODS: 50 eyes with uncontrolled POAG were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). A total of approximately 50 nonoverlapping spots were placed over 180 degrees of the TM at energy levels ranging from 0.40 to 0.92 mJ/pulse. After SLT, the eyes were maintained with the identical hypotensive medical therapy as that before treatment. IOP was estimated before and 1 day, 7 days, 1 month, 3 months and 6 months after treatment. RESULTS: The mean pretreatment IOP was 22.48 mm Hg (SD 1.84). At the end of 1 month of follow-up IOP was reduced with a mean of 4.86 mm Hg (SD 2.38) or 21.6%; after 3 months, IOP was reduced with a mean of 5.66 mm Hg (SD 2.40) or 25.2%; at the end of 6 months of follow-up, IOP was reduced with a mean of 5.06 mm Hg (SD 2.37) or 22.5%. CONCLUSIONS: SLT is an effective method for lowering IOP in the treatment of POAG.     

二极管激光经巩膜睫状体光凝治疗新生血管性青光眼

目的:评价二极管激光经巩膜睫状体光凝治疗新生血管性青光眼的疗效。方法:对52例诊断为新生血管性青光眼的患者行经巩膜的810nm激光睫状体光凝,能量为1500~3000mW,时间2000ms,范围为24~32点,随访1a,观察其治疗效果。结果:治疗前眼压为(57.78±6.46)mmHg,治疗3d后眼压为(30.8±5.41)mmHg,与治疗前相比,差异显著;随访1a后眼压为(19.44±4.38)mmHg,与治疗前相比,差异显著。所有患者的疼痛均得到缓解或消除。结论:经巩膜睫状体光凝治疗新生血管性青光眼是有效和安全的。     

Efficacy of selective laser trabeculoplasty in the treatment of primary open-angle glaucoma

BACKGROUND: Our aim was to investigate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study. PATIENTS AND METHODS: In 36 eyes of 36 patients suffering from uncontrolled POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and one day, one week, one month and 3, 6, 12, 18, 24, 30, 36, 42 and 48 months after. A failure was defined as an IOP reduction of less than 20% from pretreatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged. RESULTS: The mean follow-up time was 34 months (SD 12.9). The mean pretreatment IOP was 22.9 mm Hg (SD 2.1). At one month of follow-up, the mean IOP reduction was 5.3 mm Hg (SD 2.1) or 23.1% and at 6 months 5.6 mm Hg (SD 2.6) or 24.5%. At 12 months of follow-up, the mean IOP reduction was 5.6 mm Hg (SD 2.3) or 24.5% and at 24 months 6.2 mm Hg (SD 2.5) or 27%. At 36 months of follow-up, the mean IOP reduction was 6.4 mm Hg (SD 2.1) or 27.4% and at the end of 48 months of follow-up, the mean IOP reduction was 5.9 mm Hg (SD 2.0) or 25.4%. The success rate after 12 months determined from the Kaplan-Meier survival analysis was 97%, after 24 months 88%, after 36 months 76% and after 48 months 71%. CONCLUSION: SLT is an effective procedure for the treatment of POAG.     

Visual loss after transscleral diode laser cyclophotocoagulation for primary open-angle and neovascular glaucoma.

BACKGROUND AND OBJECTIVE: Varying incidences of visual loss after transscleral diode laser cyclophotocoagulation for uncontrolled intraocular pressure (IOP) have been reported. This study compared the treatment response in primary open-angle (POAG) and neovascular (NVG) glaucoma, particularly regarding vision loss. PATIENTS AND METHODS: Case notes of consecutive patients who underwent transscleral diode laser cyclophotocoagulation between March 2001 and September 2005 were retrospectively reviewed. A diagnosis of POAG or NVG and at least 6 months of follow-up were required for inclusion. Conservative laser parameters were used. The treatment response of the POAG and NVG groups was compared. RESULTS: Twenty-five eyes of23 patients with POAG and 14 eyes of 14 patients with NVG were studied. Mean follow-up was 22.4 and 12.9 months in the POAG and NVG groups, respectively. Post-treatment, both groups had significant reduction in mean IOP of 7.3 (29.2%) and 13.2 (36.6%) mm Hg, respectively (between group P = .18). One eye in each group had mild hypotony of 4 mm Hg, and no eyes became phthisical. Oral acetazolamide treatment was significantly reduced in both groups. Visual acuity post-treatment decreased in both groups; the POAG eyes had better initial visual acuity and lost more visual acuity. Nine of 25 (36%) POAG and 4 of 8 (50%) NVG eyes lost 2 or more LogMAR lines. CONCLUSIONS: Transscleral diode laser cyclophotocoagulation reduced IOP and medication requirements in POAG and NVG. Patients should be warned that visual loss may occur, especially in endstage glaucoma.     

Endocyclophotocoagulation for management of difficult pediatric glaucomas.

INTRODUCTION: Experience with endoscopic diode laser cyclophotocoagulation remains limited. We report the efficacy and safety profile of this glaucoma surgery technique in the pediatric population. METHODS: Retrospective review of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Surgery was performed by using the Microprobe (Endo Optiks, Little Silver, NJ) integrated laser endoscope system. Patients were followed-up for a minimum of 6 months or until declared treatment failures. Treatment success is defined as a postoperative intraocular pressure of < or = 21 mm Hg, with or without adjunctive glaucoma medications. RESULTS: Baseline mean pretreatment intraocular pressure was 35.06 +/- 8.55 mm Hg. Final postoperative intraocular pressure was 23.63 +/- 11.07 mm Hg (30% decrease) after an average of 1.42 +/- 0.87 endolaser procedures and 19.25 +/- 19.36 months of follow-up. Success rate of the initial procedure at last follow-up was 34%. Nine eyes (25%) were retreated at least once. Cumulative success rate after all procedures at last follow-up was 43%. Mean cumulative arc of treatment was 260 degrees +/- 58 degrees of ciliary processes. Postoperative complications included retinal detachment in 2 patients, hypotony in 1 patient, and progression of vision loss from hand motion to no light perception in 1 patient. All 4 complications occurred in aphakic patients. CONCLUSIONS: Endoscopic diode laser cyclophotocoagulation is a moderately effective procedure for the management of difficult pediatric glaucomas. Aphakic patients may have an increased risk of significant postoperative complications, such as retinal detachment.