Transscleral diode laser cycloablation in patients with good vision
Résumé
Patients and Methods: Patients with pre-operative VA 20/60 or better who had undergone cyclodiode treatment according to a standard protocol were evaluated retrospectively. The primary outcome variable was a recorded loss of ≥2 Snellen lines of best corrected visual acuity (BCVA) during follow-up. Successful intraocular pressure (IOP) control was defined as being between 6 and 21 mmHg inclusive without oral acetazolamide or other glaucoma surgery. Results: 49 eyes of 43 patients with a median pre-treatment acuity of 20/30 were included (range 20/16-20/60). After a mean duration of follow-up of 5.0 years, median VA was 20/60 with a ≥2 line loss recorded in 15 eyes (30.6%) (mean survival time 7.7 years). 67.3% (33/49) retained VA 20/60 or better, but VA deteriorated by 1 Snellen line or more in 31 (63.2%) and in 16.3% (8/49) final VA was <20/200. In cases experiencing a 2 line loss in acuity, the main causes were glaucoma progression (9 cases) and macula oedema (4 cases). Visual loss was unrelated to total treatment dose (mean 99.7J), initial acuity or initial IOP level. IOP was controlled at final follow-up in 39/49 (79.6%) with no cases of hypotony. Conclusions: The majority of these eyes with difficult to manage glaucoma retained their good visual acuity over long-term follow-up after undergoing diode laser cyclophotocoagulation. The proportion losing 2 Snellen lines is in line with that reported following trabeculectomy or tube surgery. These results suggest a possible role for the use of transscleral cyclodiode in selected eyes with significant visual potential. Further controlled prospective studies are required to better define this role.
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