EFFICACY AND SAFETY OF TRANSSCLERAL DIODE LASER CYCLOPHOTOCOAGULATION IN REFRACTORY GLAUCOMA PATIENTS WITH GOOD VISUAL ACUITY

Abstract

The aim of this study is to evaluate the e!icacy and safety of transscleral diode laser cyclophotocoagulation (TSDLC) treatment in refractory glaucoma patients with good visual acuity (VA). Methods The medical records of patients who underwent TSDLC treatment with a follow-up period of at least six months and preoperative best-corrected VA (BCVA) levels of 6/12 or above according to the Snellen chart were analyzed retrospectively. Results Forty-five eyes of 42 (24 male/18 female) patients were included in the study. Three eyes were excluded from the analysis due to other complications (keratitis, macular degeneration, and gra" failure a"er cataract surgery). The mean age was 64.5 ± 18 years. The mean follow-up period was 28.4 ± 20.3 months. The mean BCVA values were 0.17 ± 0.11 logMAR preoperatively and 0.19 ± 0.12 logMAR at the postoperative last visit. The di!erence was not significant statistically (p = 0.226). Preoperative mean intraocular pressure (IOP) was 24.5 ± 5.3 mmHg and decreased to 15.3 ± 4.3 mm Hg (p<0.001) at six months and 16.3 ± 5.4 mm Hg at the last visit (p<0.001). However, the mean IOP at the last visit was significantly higher than the 6th months mean IOP (p = 0.043). This indicates that the e!ectiveness of TSDLC treatment decreases in the long term. The preoperative mean number of topical antiglaucomatous medication was 3.57 ± 0.63 and decreased to 2.73 ± 1.19 at six months and 2.85 ± 0.92 at the last visit (both, p<0.001), but no di!erence was observed between the 6th months and last visit (p=0.200). A"er TSDLC treatment, BCVA decreased two lines or more in 9 cases, but six of them (3 of them due to hypotonia and three of them due to cystoid macular edema) recovered to their preoperative values at the end of the 1st month. However, in 7 (16%) eyes TSDLC treatment was required for the second time, trabeculectomy was done in 3 (7%) eyes, and Ahmed glaucoma valve implantation was done in 2 (5%) eyes. No phthisis bulbi or persistent hypotonia developed during the follow-up period. Conclusions Transscleral diode laser cyclophotocoagulation is a relatively safe and e!ective treatment method in refractory glaucoma patients with good visual acuity. In our series, no severe loss of vision was observed during follow-up time and this is encouraging for the future studies.