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Abstract #18396 Published in IGR 3-3
Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty
Shah P; Lee GA; Kirwan JK; Bunce C; Bloom P; Ficker LA; Khaw PTOphthalmology 2001; 108: 1986-1991
OBJECTIVE: This study analyzes the results of intraocular pressure (IOP) reduction by contact diode cycloablation (cyclodiode) in cases of refractory glaucoma after penetrating keratoplasty. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-eight eyes of 28 patients attending Moorfields Eye Hospital. INTERVENTION: Cyclodiode (40 applications x 1.5 W x 1.5 seconds over 270-300°) was used to control IOP in refractory glaucoma after penetrating keratoplasty. MAIN OUTCOME MEASURES: Postoperative IOP, graft status, visual acuity, and number of antiglaucoma medications were recorded after cyclodiode treatment. RESULTS: Cyclodiode resulted in a reduction of IOP from a median of 33 mmHg (interquartile range (28, 40.5)) to a median of 15 mmHg (interquartile range (12, 20.5)). Most patients had a significant lowering of IOP with a median reduction of 16 mmHg (interquartile range (12, 25); p < 0.0001). IOPs of 6-21 mmHg were achieved in 22 patients (79%); 16 patients (57%) required more than one treatment with cyclodiode to control IOP, with three (11) requiring three treatments and two (7%) four treatments. Visual acuity improved (>2 Snellen lines of acuity) in three patients (11%) and remained the same (±1 Snellen line) in 17 (61%). The mean number of antiglaucoma medications before cycloablation was 2.6, and 1.8 after treatment (p < 0.001). Of the 19 patients (68%) with originally clear grafts, three grafts (16%) developed opacification. One patient (4%), with a history of nanophthalmos and recurrent uveal effusion, had delayed hypotony (IOP <6 mmHg) occurring 46 months after the diode treatment. All patients had at least six months' follow-up. CONCLUSIONS: These patients have often undergone multiple previous complicated ocular interventions and are often not suitable for filtration surgery. Reduction of IOP with maintenance of visual acuity and a good safety profile was achieved in most patients in this study, but may require multiple treatments. The authors propose cyclodiode as an effective treatment for many patients in the management of refractory glaucoma after penetrating keratoplasty.
Dr P. Shah, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QH, UK
Classification:
9.4.11.4 Glaucomas associated with corneal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
