advertisement
Abstract #15186 Published in IGR 8-4
Transscleral diode laser cyclophotocoagulation as primary and secondary surgical treatment in primary open-angle and pseudoexfoliatve glaucoma : Long-term clinical outcomes
Grueb M; Rohrbach JM; Bartz-Schmidt KU; Schlote TGraefe's Archive for Clinical and Experimental Ophthalmology 2006; 244: 1293-1299
BACKGROUND: Transscleral diode laser cyclophotocoagulation (TDLC) has been used successfully in the treatment of refractive glaucoma. However, little is known about TDLC as a primary or secondary surgical procedure in primary open-angle and pseudoexfoliative glaucoma. METHODS: In a retrospective chart review we analyzed 90 eyes (48 OD/42 OS) in 90 patients (mean age 75 years, range 60-92 years; 51 men/39 woman) with primary open-angle glaucoma (n = 66) and pseudoexfoliative glaucoma (n = 24) who consecutively underwent TDLC with a minimum follow-up of 24 months. In 24 eyes (26.7%) TDLC was the primary surgical treatment. Mean energy was 80 J (60-92 J). Success was defined as a final intraocular pressure (IOP) between 4 and 18 mmHg, a minimum IOP reduction of 20% and the absence of major complications. RESULTS: The overall success rate was 36.7% after 24 months. A mean of 1.3 procedures was performed per patient. No correlation between age and success rate (p = 0.887) or gender and success rate (p = 0.895) was seen. There was no significant reduction in antiglaucomatous medication (p = 0.208), no significant loss of visual acuity (p = 0.324) nor a significant relationship between loss of visual acuity and failure of treatment (p = 0.201). In patients with primary open-angle glaucoma the success rate was 40.9% after 24 months; in patients with pseudoexfoliative glaucoma it was 25.0% after 24 months. There was no significant difference between primary open-angle glaucoma and pseudoexfoliative glaucoma (p = 0.684). Previous ocular surgery decreased the success probability from 45.8 to 33.3% (p = 0.001). Prolonged hypotonia occurred in 1 patient. No phthisis bulbi developed. CONCLUSIONS: Transscleral diode laser cyclophotocoagulation is an effective and safe method not only in the treatment of refractive glaucoma, but also as a primary surgical procedure in primary open-angle and pseudoexfoliative glaucoma. TDLC may be used more widely in glaucoma therapy, although further long-term studies have to confirm these findings.
Dr. M. Grueb, University of Tübingen, Department of Ophthalmology, Schleichstrasse 12, 72076, Tübingen, Germany. matthias.grueb@med.uni-tuebingen.de
Classification:
12.10 Cyclodestruction (Part of: 12 Surgical treatment)
9.2.3 Open angle glaucoma with elevated IOP (Part of: 9 Clinical forms of glaucomas > 9.2 Primary open angle glaucomas)
9.4.4.1 Exfoliation syndrome (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.4 Glaucomas associated with disorders of the lens)