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    Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty.

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    Authors
    Shah, Peter
    Lee, Graham A.
    Kirwan, James K.
    Bunce, Catey
    Bloom, Philip A.
    Ficker, Linda A.
    Khaw, Peng T.
    Issue Date
    2001
    
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    Abstract
    OBJECTIVE: This study analyzes the results of intraocular pressure (IOP) reduction by contact diode cycloablation (cyclodiode) in cases of refractory glaucoma after penetrating keratoplasty. DESIGN: Retrospective noncomparative, interventional case series. PARTICIPANTS: Twenty-eight eyes in 28 patients attending the Moorfields Eye Hospital. INTERVENTION: Cyclodiode (40 applications x 1.5 W x 1.5 seconds over 270-300 degrees ) was used to control the IOP in refractory glaucoma after penetrating keratoplasty. MAIN OUTCOME MEASURES: Postoperative IOP, graft status, visual acuity, and number of antiglaucoma medications were recorded after cyclodiode treatment. RESULTS: Cyclodiode resulted in a reduction of IOP from a median of 33 mmHg (interquartile range [28, 40.5]) to a median of 15 mmHg (interquartile range [12, 20.5]). Most patients had a significant lowering in IOP with a median reduction of 16 mmHg (interquartile range [12, 25]; P < 0.0001). IOPs of 6 to 21 mmHg were achieved in 22 patients (79%). Sixteen patients (57%) required more than one treatment with cyclodiode to control the IOP, with three patients (11%) requiring three treatments and two patients (7%) requiring four treatments. Visual acuity improved (> two Snellen lines of acuity) in three patients (11%) and remained the same (+/- one Snellen line) in 17 patients (61%). The mean number of antiglaucoma medications before cycloablation was 2.6 and was 1.8 after treatment (P < 0.001). Of the 19 patients (68%) with originally clear grafts, three grafts (16%) developed opacification. One patient (4%), with a history of nanophthalmos and recurrent uveal effusion, had delayed hypotony (IOP < 6 mmHg) occurring 46 months after the diode treatment. All patients had at least 6 months follow-up. CONCLUSIONS: These patients have often undergone multiple previous complicated ocular interventions and are often not suitable for filtration surgery. Reduction of IOP with maintenance of visual acuity and a good safety profile was achieved in most patients in this study but may require multiple treatments. We propose cyclodiode as an effective treatment for many patients in the management of refractory glaucoma after penetrating keratoplasty.
    Citation
    Ophthalmology, 108(11): 1986-1991
    Publisher
    Elsevier Science Direct
    Journal
    Ophthalmology
    URI
    http://hdl.handle.net/2436/29498
    DOI
    10.1016/S0161-6420(01)00767-9
    PubMed ID
    11713066
    Additional Links
    https://www.sciencedirect.com/science/article/pii/S0161642001007679?via%3Dihub
    http://direct.bl.uk/bld/PlaceOrder.do?UIN=104836343&ETOC=RN&from=searchengine
    Type
    Journal article
    Language
    en
    ISSN
    0161-6420
    ae974a485f413a2113503eed53cd6c53
    10.1016/S0161-6420(01)00767-9
    Scopus Count
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    Faculty of Education, Health and Wellbeing

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