Diode Laser Trans – Scleral Cyclo – ablation as a Primary Surgical Treatment for Primary Open – Angle Glaucoma after Maximum Tolerated Medical Therapy

Abstract

Introduction:  The incidence rate and prevalence of glaucoma in Pakistan is similar to that of other dark - colored population countries. Primary trabeculectomy is still a preferred surgical approach. Diode laser is widely accepted as the therapy of choice in severe gla-ucoma cases. The purpose of this study was to deter-mine the role of Diode Laser Trans-scleral Cyclo-ablation as a primary surgical treatment option in Pri-mary Open Angle Glaucoma after maximum tolerated medical therapy.

Methods:  This quasi - experimental study was con-ducted at Layton Rahmatullah Benevolent Trust Free Eye Care and Cancer Hospital, Lahore. Sixty patients fulfilling the inclusion criteria were selected from the Glaucoma unit for this study. 25 - 30 burns of Diode Laser were applied to 270 degrees avoiding 3 and 9 o clock positions, 1.5 mm posterior to the limbus. Laser was set at duration of 1 second and power between 1000 and 1500 mw. Patients were followed up for a period of one year.

Results:  Out of a total of 60 eyes with mean age 52.73 ± 7.40 years, 36 (60%) were male and 24 (40%) were female. The mean pre-operative Intra Ocular Pressure IOP was 41.0 ± 7.0 mmHg (The pre-opera-tive IOP ranged from 28 mmHg to 60 mmHg). The mean post-operative IOP was 18.97 mmHg on day one, 16.75 mmHg at 1 week, 15.68 mmHg at 1 month, 15.00 mmHg at 6 months and by the end of a year it was about 14.15 mmHg (The post-operative IOP ran-ged from 6 mmHg to 52 mmHg). There was a signifi-cant drop of more than 50% of post-operative IOP as compared to pre-operative IOP.

Conclusion:  Diode Laser Trans-scleral Cycloablation is a practical, rapid, well - tolerated procedure that provides a significant lowering of intraocular pressure with few complications and can considered as alter-native treatment in POAG if medical therapy fails.

Key Word:  Diode Laser, Trans-Scleral, Cyclo-abla-tion.