Contact transscleral cyclophotocoagulation for end stage glaucoma.

Contact transscleral cyclophotocoagulation is a form of cyclodestructive procedure, which is effective in the lowering of intraocular pressure in eyes with refractory glaucoma by destroying the aqueous humor-producing ciliary processes. Continuous wave Nd:YAG (Neodymium: Yttrium-Aluminium-Garnet) laser is used in the cyclodestruction, the laser energy being delivered to the target tissues transsclerally via a fibre-optic probe. We used the Lasag microruptor III Nd:YAG laser to treat 16 cases of refractory glaucoma to evaluate the effectiveness of laser in pain relief and intraocular pressure control. The mean preoperative intraocular pressure of 48.3 +/- 9.3 mm Hg decreased to 30.6 +/- 17.4 mm Hg (p = 0.0001) during an average follow-up of 294.2 +/- 94.2 days (range, 181-465 days). Retreatment was required in eight of 16 eyes (50%). Four eyes (27%) had decreased vision from perception of light to no perception of light. None of the 15 patients developed phthisis bulbi or other serious complications. We conclude that transscleral cyclophotocoagulation is an effective modality of therapy for refractory and end stage glaucoma. The lower than recommended total energy we used in the treatment protocol was associated with lower incidence of complications but also lower success rate and higher retreatment rate.