PURPOSE: To evaluate efficacy of trans-scleral controlled
cyclophotocoagulation (diode laser) in eyes affected by refractory glaucoma
which do not respond to maximal medical therapy.
MATERIALS AND METHODS: 15 patients were selected. IOP (intraocular
pressure) ranged between 41 and 62 mmHg despite maximal therapy. Before laser
application we performed: visual acuity, biomicroscopy of the anterior and
posterior segment, tonometry and gonioscopy. A G-probe diode laser COCO
(COntrolled COagulation) was used to perform a controlled cyclophotocoagulation
after view of the ciliary body through transillumination, maintaining fixed the
energy (5,0W). The time was adjusted by machine on the basis of light
transmission through the ciliary body and revealed by a detector piece. We
performed 16 spots (mean time=0.25sec) on 360°. Laser treatment was completed
ambulatorially in a single session. We followed-up the patients at 1, 3, 7, 30,
120, 180 days.
RESULTS: IOP decreased in all patients from the first day (IOP
range:20-26mmHg). 2 patients of 15 needed to be treated again. IOP range was
between 16-22 mmHg in all the follow-up period. After treatment patients
complained a slight pain over 2 days. Biomicroscopy showed no inflammatory
reaction in the anterior chamber and the visual acuity kept steady. No
complications were found. Medical therapy was reduced or completely sospended.
CONCLUSIONS: Controlled coagulation shows indubitable advantages. It is
simple, safe and precise. It can be controlled in real time. Obtained results
last in time.