Diode laser cyclophotocoagulation in Indian eyes: efficacy and safety

Abstract

Diode laser cyclophotocoagulation (DLCP) has emerged as a time-tested procedure for end-stage glaucoma with fewer complications. By means of this study, we have evaluated its wide indications, its efficacy, and safety in darkly pigmented Asian Indian eyes. Ninety-one eyes with uncontrolled glaucoma presenting to glaucoma clinic of a tertiary care center over a period of 6 years were scheduled for DLCP. The semiconductor diode laser with a G probe was used with laser energy delivered about 1.5 mm behind the surgical limbus. The extent of clock hours of laser application was determined by pretreatment intraocular pressure (IOP) and superior area was spared in cases where future filtration surgery was contemplated. The DLCP was repeated earliest at 1 month in case of non-response and a maximum of three laser procedures were performed for any patient. Ninety-one eyes of 89 patients (40 males, 49 females) were included. Common indications included secondary glaucoma (37.3 %), failed trabeculectomies (27.4 %), angle closure glaucoma (17.5 %), etc. Laser power delivered ranged from 990 to 1800 mW, (mean 1396 + 182.14 mW) with an average of 17 spots. Patients improved from pretreatment IOP of 38.18 + 8.96 mmHg (range 20.6-64) to post treatment IOP of 17.86 + 7.75 mmHg (range 10-42). Qualified success was defined as final IOP of 20 mm Hg or less on topical medications that could be achieved in 70 % eyes with one or repeat treatment. Pre op visual acuity ranged from PL+ to 6/18 showing a slight improvement to PL+ to 6/12 post op. A 58.5 % reduction of IOP was noted. No incidence of serious complications was noted during follow-up ranging from 9 months to 3 years. DLCP is an effective and safe tool to be used in Indian population for control of IOP. It can be safely used as a primary modality to bring IOP to permissible levels before trabeculectomy.

Efficacy of 180° Cyclodiode Transscleral Photocoagulation for Refractory Glaucoma

“…Certain studies reveal a correlation between total amount of energy and success rate 6,16 while others fail to detect this association. 7,9,11 In our study, no association was found between energy delivered and postoperative IOP. This discrepancy may stem from the fact that there is really no anatomic landmark during TS-CPC to ensure exact placement of the probe tip over the ciliary body and no method available to assess the energy delivered to the ciliary body tissue.…”

“…In a study by Murphy et al 2 in which TS-CPC was applied over 270° of the ciliary body, the IOP reduction rate was found to be 52.6% in the first 7 months of follow-up. In a similar study, Singh et al 11 found the reduction in IOP to be 58.5% at 9 months post-treatment. In the current study, the IOP reduction rate was 30.9% and 39.0% at 3 and 22.2 months, respectively.…”

Outcomes of a combination of augmented MicroPulse and limited Continuous Wave Cyclophotocoagulation in patients with refractory glaucoma

“…Our rate of Cumulative success (%) ± SE (95% confidence interval) 3 months 100.0 ± 100.0 (100.0, 100.0) 100.0 ± 100.0 (100.0, 100.0) N 34 34 6 months 91.1 ± 4.9 (81.9, 100.0) 88.1 ± 5.6 (77.9, 99. [20][21][22]. In our study, 7.9% of patients developed hyphema in the early postoperative follow-up period that spontaneously resolved in all but one patient with a concurrent diagnosis of malignant iris melanoma.…”

Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma

“…The success rate was 77.2% after the first week, 68.1% after the first month, 72.2% at 3 months, and 54.5% at 12 months, results that are similar to those of other studies. Singh et al ( 21 ) reported a success rate of 70% and Grueb et al ( 16 ), a 36.7% success rate, with different periods of follow-up.…”