Kramp K., Vick H.-P., Guthoff R.

Universitäts- Augenklinik Rostock, Doberaner Str. 140, 18055 Rostock

Objective: The transscleral cyclophotocoagulation (TSCPC) is of increasing importance for the therapy of glaucoma as an alternative to other surgical procedures. The purpose of this study was to evaluate the short- and longterm clinical effectiveness of the TSCPC with the diode laser for different types of glaucoma also as a primary surgical treatment.
Methods: A retrospective analysis after 250 TSCPC was made of 145 patients (193 eyes) with different glaucomas with an average age of 62,6 ± 17,1 years treated between November 1994 and March 1998 in the University Eye Hospital Rostock. Postoperative follow- up ranged from 6 to 48 months (Ø 13,9). Most of the patients have had Primary Open Angle Glaucoma (POAG; 51,2 %) or secundary glaucoma (24,4 %). Neovascular glaucoma (NVG) was only present in 5,2 %. Using a diode laser coupled with a fiber optic probe ending in a focussing tip, all eyes were treated with 24- 30 spots over 360° and 2,8- 3,6 J of energy, 1,5 mm posterior to the limbus.
Results: The mean intraocular pressure (IOP) decreased from 24,6 ± 6,7 mmHg before to 19,3 ± 5,7 mmHg after operation (p < 0,001). Successfull control of IOP (final IOP in the range of 10- 22 mmHg ) occured in 76,4% after a single or multiple treatments. The reduction of the maximal IOP as well as the number and frequency of application of the antiglaucomatous medications was also statistically significant (p < 0,001). The best results were obtained within the group of the patients with POAG, in the group of the oldest and in the group of the patients without any previous or following glaucoma operations. In often refractory glaucomas, as NVG and congenital glaucomas, the reduction of the IOP of 52,9 % respectively 15,0 % was successfully in 69,2 % respectively 58,3 %. 24,8 % of the cases were in need of multiple treatments with an average of 1,3 per eye. There was a complication rate of 14,4 %, mostly a mild uveitis (31 of 36). The phthisis bulbi as a serious complication was observed in 2 patients with NVG and one woman with pseudoexfoliations glaucoma.
Conclusion: The TSCPC with the diode laser is a save, effective procedure with few severe complications in reducing the IOP in the treatment of different glaucomas. It is also suited for a primary surgical treatment.

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