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Impressum
Cyclodestructive procedures in neovascular glaucoma: Transscleral cyclophotocoagulation with the diode laser versus transscleral cryotherapy
Freigassner P., Eckhardt M.
Univ.Augenklinik Graz (Vorstand: o.Univ.Prof. Dr. J.Faulborn)
Background: Neovascular glaucomas are often inadequately controlled
despite maximal medical therapy and as penetrating surgery is in most
cases unsuccessful, cyclodestructive procedures and drainage implants
seem to be the only methods for effective IOP control. Transscleral cycophotocoagulation
using a diode laser is an alternative cyclodestructive procedure to cyclocryotherapy.
Methods: retrospective study. To assess the efficacy (IOP-lowering
effect) and the complication rate of transscleral cyclophotocoagulation
(Iris Medical OcuLight SLx, G-Sonde) versus cyclocryotherapy in 94 eyes
of 94 patients with neovascular glaucoma. Follow-up: -3 years
Results: TSCPC: 43 eyes of 43 patients, präop. IOP: 47+-10.3mm
Hg (27 -74 ), postop. 1 week: 26,7+-10.2mm Hg (10 -50), 1 month: 29,5+-12.5mm
Hg (9- 56), 3 months: 19.3+-12.8mm Hg (0-50), 6 months: 13,3+-13.3mm Hg
(0- 36), 12 months: 10.6+-11.9mm Hg (0-44), 2 years: 7.8+-8.8mm Hg (0-28),
3 years: 7.5+-15.0mm Hg (0-30) Complications: drop of visual acuity (at
least two lines in 3 years) : 39.5%; loss of visual acuity: 19.6%, chronic
ocular hypotony (<6mm Hg): 21.4%, phthisis bulbi: 13.9%, enucleation-rate:
2.3%. Transscleral cryotherapy: 51 eyes of 51 patients, präop. IOP:
43.6+- 13.4mm Hg (25 -72 ), postop. 1 week: 23.6+-11.0mm Hg ( 7-60), 1
month: 15.2+-9.6mm Hg (0-38), 3 months: 14,7+-13.3mm Hg (0-42), 6 months:
10.6+-9.0mm Hg (0-24), 12 months: 8.2+-11.5mm Hg (0-36), 2 years: 6.5+-
6.6mm Hg (0-19), 3 years: 8.6+-7.4mm Hg (0-23) Complications: drop of
visual acuity (at least two lines in 3 years): 45%; loss of visual acuity:
25.6%, chronic ocular hypotony (<6mm Hg): 33.4%; phthisis bulbi: 13.7%,
enucleation-rate : 9.8%.
Conclusion: Diode laser TSCPC appears to be as effective as cyclocryotherapy
for treating neovascular glaucoma (significantly higher IOP-lowering effect
with cryocoagulation only after the first month of follow up). Complications
as chronic ocular hypotony, visual drop and visual loss were major following
cyclocryotherapy . The phthisis rate did not differ between both procedures.