Efficacy and Safety of Contact Transscleral Diode Laser Cyclophotocoagulation for Advanced Glaucoma

Schlote, Torsten; Derse, Matthias; Rassmann, Katja; Nicaeus, Thilo; Dietz, Klaus; Thiel, Holger

doi:10.1097/00061198-200108000-00009

Cited by 153 publications

(149 citation statements)

References 35 publications

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“…The combination of several advantages has encouraged several groups to study the various aspects of this treatment. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Some studies have made use of these facts to attempt even primary treatment of high-risk patients, 3,18 and to compare results of cyclophotocoagulation to better-established treatment options, such as filtering surgery, and drainage implants. Unfortunately, most of these studies were retrospective, with significant variability in the energy settings and in the number of applications making comparison and inference quite difficult.…”

Section: Discussionmentioning

confidence: 99%

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Diode laser transcleral cyclophotocoagulation for refractory glaucoma: a 1 year follow-up of patients treated using an aggressive protocol

Noureddin

Zein

Haddad

et al. 2005

Eye

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Purpose To prospectively evaluate the intraocular pressure (IOP) lowering ability, retreatment rate, and complications of transcleral Diode laser cyclophotocoagulation using a higher power setting than what is generally recommended. Patients and methods A total of 36 eyes of thirty six patients with refractory glaucoma, and who fitted our inclusion criteria underwent Diode cyclophotocoagulation. The laser power was set at 2250 mW, with a duration of 2000 ms, and a total number of 28 shots for the first treatment and 20 shots for any consequent one. The patients were followed up for 1 year with the following outcomes being analysed: IOP, visual acuity, change in the number of medications, and complications. Results The mean IOP decrease was 53% (Po0.05), and 72.2% of the patients maintained an IOP r21 mmHg for the whole duration of the study The number of medications necessary to control the pressure, significantly dropped from 2.8 to 0.89 (Po0.05), and 25% of the patients needed the treatment to be repeated only once. In all, 33% of the patients improved their visual acuity after the treatment, while 22% worsened, and the rest stayed the same. The most common treatment complications were conjunctival injection and corneal oedema, and these were both transient and reversible. Conclusion The use of the higher power setting of 2250 mW, resulted in a sustained lower IOP, less use of medications, less need for retreatment, relative preservation of visual acuity, and only reversible complications.

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Section: Discussionmentioning

confidence: 99%

“…2,3,[11][12][13]15 We speculate that a safe power setting resulting in the required pressure lowering with a low rate of retreatments, cannot be but associated with a lower incidence of hypotony in the long run. Only one patient (2.7%) developed relative hypotony in this study, compared to a range of 1-2% in the literature.…”

Section: Eyementioning

confidence: 99%

Diode laser transcleral cyclophotocoagulation for refractory glaucoma: a 1 year follow-up of patients treated using an aggressive protocol

Noureddin

Zein

Haddad

et al. 2005

Eye

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“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The chief drawback of these procedures as a group is a narrow therapeutic window, which implies that there is a very small safety zone in which it is effective without causing significant complications. Currently, transcleral laser cyclophotocoagulation (TSCPC) procedures appear to provide the best combination of effectiveness, portability, expense, and ease of use.…”

Section: Introductionmentioning

confidence: 99%

“…10 The most frequently used lasers for this modality of treatment are the 1064 nm Nd:Yag lasers [8][9][10][11] and 810 nm semiconductor diode. [12][13][14][15][16][17][18][19][20][21][22][23][24] Both wavelengths can produce thermal tissue damage, and there is evidence that the semiconductor diode laser with 810 nm wavelength exhibits less scleral transmission and considerably greater absorption by melanin compared to the 1064 nm Nd:Yag laser. 25 The clinically significant effect is that the energy needed to produce comparable lesions is less with the diode laser compared to that required by the Nd:YAG laser.…”

Section: Introductionmentioning

confidence: 99%

Lower energy levels adequate for effective transcleral diode laser cyclophotocoagulation in Asian eyes with refractory glaucoma

Kaushik

Pandav

Jain

et al. 2006

Eye

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Purpose To study the treatment parameters for diode laser cyclophotocoagulation (DLCP) in Asian Indian eyes using laser energy titrated to clinical response. Methods This prospective interventional longitudinal study included 66 eyes of 66 patients with varied aetiology refractory glaucoma, no previous cycloablation, and minimum 1 year follow-up. DLCP was performed using the Oculight s Diode laser system (IRIS & Medical Instruments Inc., CA, USA). Power used per spot was titrated according to the audible 'pops' indicating tissue microexplosion. The mean laser energy delivered, post-laser intraocular pressure (IOP) reduction, complications, and requirement of re-treatment in various subgroups were analyzed. Differences in energy delivered in each subgroup were assessed by analysis of variance with post hoc Bonferroni corrections. Linear regression analysis was used to identify possible predictive factors for failure of cyclodiode therapy. Results The mean total energy delivered per eye was 87.80731.8 J (range 105.4736.8 J in neovascular glaucoma (NVG) to 61.578.8 J in uveitic glaucoma (P ¼ 0.134)). Mean pre treatment IOP was 36.4710.7 mmHg, which reduced to 19.479.8 mmHg (Po0.001) at 1 week, and 15.676.6 mmHg at 1 year. At 1 year, 58 of 66 patients had IOPo22.0 mmHg (response rate 87.8%), and six patients had hypotony (success rate 78.8%). The uveitic glaucoma group had 100% success rate. NVG group required maximum re-treatments. Conclusions DLCP with a titrated energy protocol needs resulted in lower energy in Asian Indian eyes compared to that reported in literature, and different energy levels are needed for different diseases. 'Standard treatment parameters' for DLCP may be inappropriate for all diseases and all races.

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“…[1][2][3] To the best of our knowledge, there were two reported cases of scleral perforation due to DLTSC in the published literature. 10,11 The case reported by Gaasterland and Pollack 9 was thought to be due to the sharp edge of the probe cutting conjunctival vessels and causing bleeding. Thin adherent debris was then carbonized, allowing the laser tip temperature to rise and causing scleral perforation.…”

Section: Commentmentioning

confidence: 99%

Scleral perforation following diode laser trans-scleral cyclophotocoagulation

Kwong

Tham

Leung

et al. 2005

Eye

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microsporidia spores, which were confirmed by 1% acid-fast stain. Polymerase chain reaction (PCR) for microsporidia was performed using primers capable of identifying several Enterocytozoon and Encephalitozoon species of microsporidia. 3 A single B270 base pair fragment was observed on agarose gel electrophoresis and ethidium bromide staining of the PCR amplified patient sample (Figure 2b). Topical steroids were discontinued and he was treated with topical 0.3% ciprofloxacin eight times daily along with topical lubricants. After 10 days, all his lesions had disappeared (Figure 1b). The patient was seronegative for HIV by ELISA test.Bilateral punctate epithelial keratopathy and conjunctivitis has been described in immunocompromised 1,2 and more recently in immunocompetent patients as well. 4,5 Previously described risk factors like trauma, contact lens wear, prior refractive surgery or exposure to contaminated water were absent in our patient. The only possible associated risk in this case was the use of topical steroids, leading to a localized immunosuppressed state, resulting in secondary infection by microsporidia. In our patient, diagnostic debridement probably debulked the epithelium of the load of organisms and hastened resolution. Contrary to belief that debridement worsens the infection by driving the organisms into the stroma; we found that debridement actually hastens resolution. 2 CommentTo the best of our knowledge, this is the first report of keratoconjunctivitis caused by microsporidia in a corneal graft. As a result of local immunosuppression, this infection can occur in patients who have been grafted, which has not previously been described. The differential diagnosis of microsporidial keratitis should be considered in this subset of patients presenting with typical features of multiple epithelial lesions in the cornea.

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Efficacy and Safety of Contact Transscleral Diode Laser Cyclophotocoagulation for Advanced Glaucoma

Abstract: Transscleral diode laser cyclophotocoagulation is an effective and safe method for the treatment of advanced, refractory glaucoma. However, repeated treatments are often necessary. Success of treatment depends on the age of patients, previous surgery, and the type of glaucoma.

Cited by 153 publications

References 35 publications

Diode laser transcleral cyclophotocoagulation for refractory glaucoma: a 1 year follow-up of patients treated using an aggressive protocol

Diode laser transcleral cyclophotocoagulation for refractory glaucoma: a 1 year follow-up of patients treated using an aggressive protocol

Lower energy levels adequate for effective transcleral diode laser cyclophotocoagulation in Asian eyes with refractory glaucoma

Scleral perforation following diode laser trans-scleral cyclophotocoagulation

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