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Abstract #10007 Published in IGR 5-3
A two center study of the dose-response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma
Murphy CC; Burnett CA; Spry PG; Broadway DC; Diamond JPBritish Journal of Ophthalmology 2003; 87: 1252-1257
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 centers was undertaken. RESULTS: Mean intraocular pressure (IOP) decreased significantly from 40.7 mmHg (SD 13.7) before cyclodiode therapy to 17.7 mmHg (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 mmHg 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. CONCLUSIONS: 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.
Dr. C.C. Murphy, Division of Ophthalmology, University of Bristol, Bristol, UK
Classification:
12.10 Cyclodestruction (Part of: 12 Surgical treatment)
