Background/Aim. Refractory glaucoma is glaucoma resistant to conventional
management (maximally tolerated medical therapy, one or more glaucoma
surgeries) and glaucoma in cases of neovascularisation after panretinal
photocoagulation or cryoablation. The aim of the study was to determine the
intraocular pressure (IOP) lowering efficacy of transscleral diode laser
cyclophotocoagulation (DCPC) treatment in the management of pain and IOP in
patients with refractory glaucoma. Methods. This nonrandomized, retrospective
study, included 95 patients (95 eyes) with refractory glaucoma treated at the
University Eye Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia,
between November 2007 and November 2012 in accordance with the established
protocols (16-18 spots, 270?, up to 5J of energy). All the eyes were treated
with transscleral DCPC (Iris Medical OcuLight SLx, Iridex Co, Mountain View,
USA). Patient's symptoms, bests corrected visual acuity and IOP were recorded
7 days, and 1, 3 and 6 months after the DCPC treatment. Results. Out of 95
patients (95 eyes) enrolled in this study 24 (25.2%) were with primary (the
group I), and 71 (74.5%) with secondary (the group II) glaucoma. The mean
baseline IOP in these two groups was similar: 36.08 ? 8.39 mmHg for the first
group and 37.36 ? 8.19 mmHg in the second group. Measurement of the mean IOP
in the group I showed the following results: on the day 7 it was 13.96 ? 8.30
mmHg (62.1% decrease of the baseline value), on the day 30 it was 18.44 ?
8.85 mmHg (48.9% decrease regarding the baseline value), after 3 months it
was 22.44 ? 7.36 mmHg (37.8% decrease regarding the baseline value), and
after 6 months it was 25.92 ? 7.65 mmHg (28.2% decrease regarding the
baseline value). Measurement of IOP in the group II showed the following
results: on the day 7 it was 15.77 ? 9.73 mmHg (57.8% decrease of the
baseline value), on the day 30 it was 20.14 ? 10.20 mmHg (46.1% decrease
regarding the baseline value), after 3 months it was 23.46 ? 9.83 mmHg (37.2%
decrease regarding the baseline value) and after 6 months it was 27.23 ? 9.87
mmHg (27.2% decrease regarding the baseline value). Pain was the main symptom
in 70 (73.6%) patients before the treatment and it persisted in only 4 (4.2%)
of our patients. Other complaints (burning, stinging, foreign body sensation)
were experienced by 39 (41%) of the patients, postoperatively. A total of 52
(54.7%) patients had no complaints after the treatment. Conclusion. Our study
confirmed that transscleral DCPC is a useful, effective and safe procedure
with predictable amount of IOP decrease, which makes it the treatment of
choice for refractory glaucoma.
A two centre study of the dose-response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma
