Diode laser transcleral cyclophotocoagulation for refractory glaucoma: a 1 year follow-up of patients treated using an aggressive protocol

Purpose To prospectively evaluate the intraocular pressure (IOP) lowering ability, retreatment rate, and complications of transcleral Diode laser cyclophotocoagulation using a higher power setting than what is generally recommended. Patients and methods A total of 36 eyes of thirty six patients with refractory glaucoma, and who fitted our inclusion criteria underwent Diode cyclophotocoagulation. The laser power was set at 2250 mW, with a duration of 2000 ms, and a total number of 28 shots for the first treatment and 20 shots for any consequent one. The patients were followed up for 1 year with the following outcomes being analysed: IOP, visual acuity, change in the number of medications, and complications. Results The mean IOP decrease was 53% (P<0.05), and 72.2% of the patients maintained an IOP <= 21 mmHg for the whole duration of the study The number of medications necessary to control the pressure, significantly dropped from 2.8 to 0.89 (P<0.05), and 25% of the patients needed the treatment to be repeated only once. In all, 33% of the patients improved their visual acuity after the treatment, while 22% worsened, and the rest stayed the same. The most common treatment complications were conjunctival injection and corneal oedema, and these were both transient and reversible. Conclusion The use of the higher power setting of 2250 mW, resulted in a sustained lower IOP, less use of medications, less need for retreatment, relative preservation of visual acuity, and only reversible complications.