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Glaucoma Dialogue IGR 12-3

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Comment by Kuldev Singh on:

26370 Transscleral diode laser cycloablation in patients with good vision, Rotchford AP; Jayasawal R; Madhusudhan S et al., British Journal of Ophthalmology, 2010; 94: 1180-1183

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Rotchford et al. present a retrospective review of a series of patients undergoing transcleral diode laser cyclophotocoagulation. This series is unique in that the subjects of the report have, for the most part, better visual acuity than most such series assessing cyclodestructive procedures. The mean follow up of five years is most impressive and this work clearly adds to our understanding of such treatment. The authors make a compelling argument that transcleral diode laser cyclophotocoagulation should be considered as an alternative to conventional glaucoma filtration surgery and drainage device implantation in patients with good central visual acuity despite difficult to control glaucomatous disease.

One of the greatest challenges of glaucoma treatment is that no therapy lasts forever and one should maximize the number of options available for each patient. Patients who have either trabeculectomy or tube implantation are amenable to treatment with cyclodestructive procedures while the reverse is often not the case

The IOP lowering to a mean of 15.3 mmHg and reduction in glaucoma medications to a mean of 1.9, while impressive, falls short by approximately 3 mmHg IOP and half a glaucoma medication relative to the tube and trabeculectomy groups in the prospective TVT study. It should be noted, however, that the TVT group had a 'healthier' study population with regard to glaucoma and has reported three- but not five-year follow up to date. One of the greatest challenges of glaucoma treatment is that no therapy lasts forever and one should maximize the number of options available for each patient. Patients who have either trabeculectomy or tube implantation are amenable to treatment with cyclodestructive procedures while the reverse is often not the case. Thus proceeding down the algorithm of care remains a limitation of early cyclodestructive surgery in many such eyes.

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