Long - term Effect of Transscleral Diode Laser Cyclophotocoagulation in Treatment of Refractory Glaucoma

AIM: 
To evaluate the long-term efficiency of diode laser transscleral cyclophotocoagulation (DL Tscpc) for refractory glaucoma.


METHODS: 
Retrospective analysis was made in 431 eyes with refractory glaucoma treated by DL Tscpc
with lower energy power (1.5-2.5W) and more laser spots (26-34). Intraocular pressure (IOP), visualacuity, ocular symptoms and complications were observed after DLTscpc. Patients were followed up over 36 months.


RESULTS: 
Mean pre-operative IOP was (56.2±12.7)mmHg which was significantly different from the final follow-up mean IOP (17.3±8.8)mmHg. (P < 0.05). The success rate was 94.4% (68/72). Postoperative visual acuity kept no change in 399 eyes; elevated in 30 eyes and decreased in two eyes. The pain sense disappeared or remarkably relieved. The main complications included mild uveitis and hyphemae. Atrophy of eyeball occurred in two eyes.

CONCLUSION: 
It is concluded that DL TScpc is a simple, safe and effective therapy for eyes with refractory glaucoma through long-term observation.

KEYWORDS: 
Diode laser; cyclophotocoagulation; refractory glaucoma


Introduction
Refractory glaucoma refers to the application of drugs and surgery are difficult to control glaucoma. Used to the conventional type of glaucoma filtration surgery, or ciliary body destructive procedures, such as frozen or ciliary body ciliary body electric coagulation. However, the clinical effect of Poor, and more complications. Our diode laser transscleral cyclophotocoagulation (diode laser transclero-cyclophotocoagulation, DL Tscpc) treatment of refractory glaucoma 690 cases of 697, of which 430 cases of 431 that we tracked 3a above, results were satisfactory. Are reported below.


1 Subjects and Methods
1.1 Object
430 cases of 431, male 255, female 176, aged 16 to 89 (mean 52) years old. These include neovascular glaucoma, 213 (49.4%), complex ocular trauma secondary glaucoma 17 (3.9%), high intraocular pressure after silicone oil injection for 8 (1.9%), primary angle-closure glaucoma absolute phase 187 (43.4%), primary open-angle glaucoma, 4 (0.9%), congenital glaucoma in 2 eyes (0.5%). Are pre-treatment application of multi-drug combination therapy intraocular pressure is still ≥ 40mmHg (1mmHg = 0.33kpa). Pre-treatment visual acuity light perception to 0.25. Instruments is the semiconductor lasers, wavelength 810nm, power 100 ~ 2 500mW, time of 10 ~ 5 000ms. Cpc probe of its front-end for a round cap with a contact probe, the diameter of 3mm, the laser beam can be precisely focused on the location of the sclera after 1.5mm.


1.2 Methods: 
The preoperative intraocular pressure lowering drugs was added, where appropriate, will
be reduced to the lowest possible level of intraocular pressure. Patient was supine, with 20g / L lidocaine 2.5mL and 7.5g / L bupivacaine 1.5mL mixed Across retrobulbar anesthesia, the laser fiber placed in contact with the first central government after the corneoscleral margin of 1.5 ~ 2mm Department, probe directed towards the ciliary body crown, hit radio range of Cape scleral edge of the week, in addition to internal and external rectus two time zones, the uniform distribution of 26 ~ 34 hit radio spots, each spot between the interval 1.5 ~ 2.0mm, laser energy use 1.5 ~ 2.5W, time 1.0 ~ 2.0s, starting from the 1.5W, hit fire and did not hear the explosion that increased 0.1W, if the continuous treatment of 3:00 have pops and a decrease 0.1W. After partial adrenal cortex hormones and antibiotics given to drug points, eyes, and symptomatic use IOP lowering drugs, oral pain medications when necessary. If the postoperative intraocular pressure control is not satisfactory, 1mo after re-DLTscpc, methods and the same as the initial
treatment. The patient's visual acuity, intraocular pressure, as well as the conjunctiva, cornea, anterior chamber, iris, lens and other organizations, the situation changes and conduct follow-up observation of medication, follow-up period were less than 3a.


2 Result
2.1 Efficacy criterion: cure: After treatment, IOP ≤ 21mmHg; markedly: more than 3 antihypertensive drugs with IOP ≤ 21mmHg, and decreased by 20% compared with before surgery. Invalid: intraocular pressure decreased less than 20%.

2.2 IOP: The mean preoperative intraocular pressure (56.2 ± 12.7) mmHg, mean IOP of last follow-up (17.3 ± 8.80) mmHg. After a sub-DL Tscpc IOP 356 eyes of 431 patients were lower than 21mmHg, surgery rate was 82.6%. 69 Line 2 DL Tscpc surgery, of which 57 IOP ≤ 21mmHg, 3 Yan IOP decreased by 20% compared with preoperative patients without eye pain discomfort. Operation invalid 9 eyes, 2 for complex ocular trauma secondary glaucoma, four for neovascular glaucoma, one for primary angle-closure glaucoma absolute period, two for the high intraocular pressure after silicone oil injection; invalid After statistical analysis, operation efficiency with age, gender, disease duration, IOP was no significant correlation (P> 0.05). In this group of 431 post-operative 1wk; 1, 3, 6, 12, 24, 36,48, 60mo intraocular pressure were observed in different periods of analysis, were lower than preoperative IOP, differences were statistically significant 


2.3 Vision: 431 eyes of 399 no change in visual acuity. 30 visual acuity was improved, including 11 from the pre-treatment visual acuity after treatment index / 30cm up to 0.04 ~ 0.05, between 8 after treatment visual acuity from 0.02 to 0.06 between pre-treatment increased to 0.1 ~ 0.25, 10 from the light-sensing to improve to the index / 30cm ~ 0.02. 2 from light perception visual acuity dropped to light perception.

2.4 Subjective symptoms: After treatment, 431 were eye pain disappeared or eased.

2.5 Complications: postoperative hyphema 7, anterior chamber exudation 13, symptomatic hemorrhage after treatment 1mo absorption, inflammation disappeared. 2 eyeball atrophy, a row before surgery Time cyclocryotherapy, a line three times in patients with transscleral cyclophotocoagulation. 

2.6 Treatment of the relationship between the number and efficacy of 431 eyes of 356 (82.6%) treatment 1 Successful, 57 (13.2%) treatment of two successful, 7 eyes (1.6%) treatment three times successfully, the cumulative success rate (97.4%).

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