Contact cw-Nd:YAG laser cyclophotocoagulation for treatment of refractory glaucoma.

Contact cw-Nd:YAG laser transscleral cyclophotocoagulation was performed on 42 patients (44 eyes) with glaucoma who were not responding to medical treatment or had failure of prior surgical procedures. No selection was made as to the type of glaucoma (congenital, primary, secondary due to trauma or inflammation). We applied between 16 and 60 exposures 0.5-2 mm posterior to the limbus. Prior to cyclophotocoagulation the mean intraocular pressure (IOP) was 40.4 mm Hg (+/- 8.0). As a result of the treatment, the mean IOP was lowered to 21.1 mm Hg (+/- 5.2). In eyes with congenital, neovascular, and inflammatory glaucoma, a therapeutic effect could only be achieved by repeated coagulations. The patients were followed for a mean of 4.8 months (3-7 months). One eye developed a transient choroidal detachment. In two eyes, iris hemorrhages were noted. Contact cyclophotocoagulation is generally well tolerated. Randomized studies are to be carried out to confirm whether cyclophotocoagulation is an effective tool in the treatment of glaucoma. Until then, cyclophotocoagulation should be restricted to cases not responding to conventional therapy.