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Abstract #15640 Published in IGR 2-3
Transscleral diode laser cyclophotocoagulation for the treatment of refractory glaucoma secondary to inflammatory eye diseases
Schlote T; Derse M; Zierhut MBritish Journal of Ophthalmology 2000; 84: 999-1003
BACKGROUND: Inflammatory glaucoma is still a diagnostic and therapeutic dilemma and surgical intervention is always associated with a high risk of failure or reactivation of the inflammatory disease. In this study, the authors prospectively examined the value of transscleral diode laser cyclophotocoagulation (TDLC) for the treatment of refractory inflammatory glaucoma. METHODS: Twenty-two eyes of 20 consecutive patients with inflammatory, medically uncontrollable, glaucoma secondary to chronic uveitis/trabeculitis (n = 18), chemical injury (n = 2), episcleritis (n = 1), and necrotizing scleritis with inflammation (n = 1) were treated by TDLC. Nine eyes (41%) had had previous failed glaucoma surgery (trabeculectomy, cyclocryocoagulation) and 15 eyes (68.2%) had had previous anterior segment surgery. All patients were followed for one year after the initial treatment. RESULTS: Within 12 months of the first treatment, the intraocular pressure was controlled in 77.3% of all eyes (72.2% of those with uveitic glaucoma). No serious side-effects such as activation of the inflammatory process, phthisis bulbi or persistent hypotonia were observed, except in one patient with a temporary fibrin reaction. More than one treatment was necessary in 63.6% of the patients. The use of systemic carbonic anhydrase inhibitors was reduced from 68.2% before treatment to 27.3% after one year. CONCLUSIONS: TDLC seems to be a safe and effective procedure for the treatment of inflammatory glaucoma and may become an alternative to trabeculectomy with antimetabolites in uveitic glaucoma. TDLC may become the surgical procedure of choice in treating secondary glaucoma caused by chemical injury and also in scleritis associated glaucoma, using reduced parameters for application.
Dr. T. Schlote, Department of General Ophthalmology and Experimental Ophthalmic Surgery, University Eye Hospital, Tübingen, D-72076, Germany. Torsten.Schlote@med.uni-tuebingen.de
Classification:
9.4.6 Glaucomas associated with inflammation, uveitis (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
12.10 Cyclodestruction (Part of: 12 Surgical treatment)
