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Peter R. Egbert, MD; Seth Fiadoyor, MD; Donald L. Budenz, MD; Patience Dadzie, RN; Sally Byrd, MD

Arch Ophthalmol. 2001;119:345-350.

Objectives  To evaluate the feasibility of diode laser transscleral cyclophotocoagulation (TSCPC) as a primary surgical treatment for primary open-angle glaucoma and to compare 2 laser energy settings used for treatment.

Methods  In a prospective clinical trial in Cape Coast and Accra, Ghana, 1 eye of each of 92 patients with primary open-angle glaucoma was treated by diode laser TSCPC as a primary surgical treatment. Eyes were randomly assigned to receive treatment by 20 applications of either 1.5 W applied for 1.5 seconds or 1.25 W applied for 2.5 seconds.

Results  Seventy-nine (86%) of 92 patients completed 3 months of follow-up; follow-up was 13.2 ± 6.0 months (mean ± SD). Intraocular pressure decreased in 53 (67%) of the 79 eyes. The drop in intraocular pressure was 20% or more in 37 eyes (47%) and final intraocular pressure was 22 mm Hg or less in 38 eyes (48%). An atonic pupil was a previously unreported complication that arose in 27 (28%) of 92 eyes. There were no serious complications of hypotony, phthisis bulbi, or sympathetic ophthalmia. Visual acuity decreased in 18 (23%) of 79 eyes treated by TSCPC and in 10 (23%) of 47 fellow eyes treated only with glaucoma medications. There was no difference in outcomes between the 2 laser energy settings.

Conclusions  Diode laser TSCPC is a practical, rapid, well-tolerated procedure that may provide a modest and variable lowering of intraocular pressure. The treatment, used with conservative energy levels applied to the eye, seems to have few serious complications, although a previously unrecognized complication of atonic pupil needs further evaluation. A moderate variation in laser energy settings does not influence the results of treatment.

From the Department of Ophthalmology, Stanford University, Stanford, Calif (Drs Egbert and Byrd); Cape Coast Christian Eye Clinic, Cape Coast, Ghana (Dr Fiadoyor and Ms Dadzie); and the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Fla (Dr Budenz). The authors have no financial interest in and no paid consulting arrangement with IRIS Medical Instruments, Mountain View, Calif.

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