This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Murphy, C C Articles by Diamond, J P Search for Related Content PubMed PubMed Citation Articles by Murphy, C C Articles by Diamond, J P

A two centre study of the dose-response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma

¹ Division of Ophthalmology, University of Bristol, Bristol, UK
² Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
³ Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK

Correspondence to:
Correspondence to:
Mr J P Diamond, Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK;
j.p.diamond{at}bristol.ac.uk

Background/aims: Transscleral diode laser cyclophotocoagulation ("cyclodiode") is widely used to treat refractory glaucoma. The main aims of this study were to investigate the dose-response relation of cyclodiode and to evaluate possible predictive factors that would help establish optimum treatment parameters.

Methods: A retrospective analysis of the case notes of 263 eyes of 238 consecutive patients who underwent transscleral diode laser cyclophotocoagulation at two centres was undertaken.

Results: Mean intraocular pressure (IOP) decreased significantly from 40.7 mm Hg (SD 13.7) before cyclodiode therapy to 17.7 mm Hg (SD 10.9) post-treatment, a reduction of 52.6% (p = 0.0001). Following cyclodiode, 89% of patients achieved an IOP of less than 22 mm Hg or a greater than 30% drop in IOP. Hypotony occurred in 9.5% of patients, 76% of whom had neovascular glaucoma. A linear dose relation response was found for the 122 eyes with neovascular glaucoma (p = 0.001) but not for the group as a whole. Treatment failure was associated with male sex (multivariate regression analysis, p = 0.008) and low mean energy per treatment session (univariate analysis alone, p = 0.016). High pretreatment IOP (p = 0.031) and high mean energy per treatment episode (p = 0.001) appeared to be associated with the occurrence of hypotony, although multivariate analysis did not support this finding.

Conclusion: Cyclodiode therapy is highly effective but there is a significant risk of hypotony, which may be reduced by applying lower energy in cases of very high pretreatment IOP and in neovascular glaucoma. The dose-response association remains unpredictable, although a linear relation was found for neovascular glaucoma.

Keywords: cyclodiode; transscleral diode laser cyclophotocoagulation; refractory glaucoma; dose-response

This article has been cited by other articles:

				M E Iliev and S Gerber Long-term outcome of trans-scleral diode laser cyclophotocoagulation in refractory glaucoma Br. J. Ophthalmol., December 1, 2007; 91(12): 1631 - 1635. [Abstract] [Full Text] [PDF]

				V W Y Wong, T Y Y Lai, and D S C Lam Retinectomy for intractable glaucoma Br. J. Ophthalmol., October 1, 2004; 88(10): 1352 - 1353. [Full Text] [PDF]