Diode Laser Trans-Scleral Cycloablation as Surgical Treatment for Primary Open ? Angle Glaucoma after Maximum Tolerated Medical Therapy

Abstract

Purpose: To establish the role of Diode Laser Trans-scleral Cycloablation (DLCA) as a primary treatment choice in Open Angle Glaucoma (POAG) after maximum endured medical therapy.
Material and Methods: It is a quasi-experimental study which was conducted at Layton Rahmatullah Benevolent Trust Free Eye Care and Cancer Hospital, Lahore (LRBT). The duration of study was 1 year (29-03-2013 to 29-03-2014). Sixty patients meeting the inclusion criteria (Inclusion Criteria were Primary Open Angle Glaucoma and Maximum tolerated oral / topical medication) Were selected from the Glaucoma unit of LRBT for this study. Twenty five to 30 burns of Diode Laser were applied to 270 degrees avoiding 3 and 9 o clock positions, 1.5 mm posterior to the limbus. Laser was set at duration of 1.5 seconds and power between 1500 and 2000 mw. The power was attuned till a popping sound was heard and then reduced to just below that level. Patients were followed up for a period of one year.
Results: Out of a total of 60 eyes with mean age 52.73 ± 7.40 years, 36 (60%) were male and 24 (40%) were female. The mean pre-operative IOP was ± 41.62 mm Hg (The pre-operative IOP ranged from 28 mm Hg to 60 mm Hg). The mean post-operative IOP was 18.97 mm Hg on day one, 16.75 mm Hg at 1 week, 15.68 mm Hg at 1 month, 15.00 mm Hg at 6 months and by the end of a year it was about 14.15 mm Hg (The post-operative IOP ranged from 6 mmHg to 52 mm Hg). There was a considerable drop of more than 50% of post-operative IOP in contrast to pre-operative IOP.
Conclusion: Diode Laser Trans-scleral Cycloablation is a convenient, swift, well – endured modus operandi that provides a modest and variable lowering of intraocular pressure with few Complications.