Rakhi Mehta,¹ George Puthuran,¹ Ramaswami Krishnadas,¹ Rajendra Mahalakshmi^2
1Glaucoma Service, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, and ²Department of Biostatistics, Lions Aravind Institute of Community Ophthalmology, Madurai, Tamil Nadu, India

Aim: To investigate the efficacy and safety of contact transsceleral diode laser cyclophotocoagulation for refractory glaucomas in a South Indian population.
Patients and Methods:106 eyes of 97 patients with refractory glaucoma and uncontrolled ocular pressures on maximum tolerated medical treatment with high risk of failure of glaucoma filtering surgery received contact transscleral diode cyclophotocoagulation and were retrospectively analysed for safety and efficacy of the procedure. The aetiologies were categorised as congenital (n = 30; 28.3%), rubeotic (28; 26.4%), post-traumatic (13; 12.3%), chronic angle closure glaucoma (6; 5.7%), post-penetrating keratoplasty (3; 2.8%) and others (21; 19.8%).
Results: Mean intraocular pressure decreased significantly from 39.6 ± 9.9 to 22.6 ± 0.9, a 59% reduction (p = 0.000) after 3 to 18 months of follow-up. Significant intraocular pressure reduction (p = 0.000) was seen in all groups except post-vitreoretinal surgery eyes. Success defined as intraocular pressure <22 mm Hg occurred in 75 eyes (70.8%) with a single treatment and in 31 eyes (29.2%) with multiple treatments (mean no. of treatments, 1.6). Overall, the technique had a response rate of 44.3% and a success rate of 39.6%; the retreatment rate was 29%. Hypotony was the most frequent adverse event (4.7%).
Conclusions: Contact transscleral diode cyclophotocoagulation effectively lowers intraocular pressure in eyes with refractory glaucomas with high risk of failure with glaucoma filtering surgery with few side effects in our population.

Key words: Filtering surgery, Glaucoma, Laser coagulation, Reoperation, Treatment outcome

Asian J Ophthalmol 2006;8:232-235.