Efficacy and safety of pop-titrated versus fixed-energy trans-scleral diode laser cyclophotocoagulation for refractory glaucoma.


Alejandro Rodriguez-Garcia


Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ophthalmology and Visual Sciences Institute, Centro Medico Zambrano Hellion, Av. Batallon de San Patricio No. 112. Col. Real de San Agustin, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico. [Email]


OBJECTIVE : To compare the efficacy and safety of pop-titrated versus fixed-energy diode laser trans-scleral cyclophotocoagulation (DLTSC) for refractory glaucoma.
METHODS : This is a prospective, interventional, longitudinal, and comparative case-control study. Patients with refractory glaucoma treated with pop-titrated DLTSC were compared to a fixed-energy DLTSC control group. Variables analyzed included: age, gender, diagnosis, pre- and post-treatment intraocular pressure (IOP). Success rate, anti-glaucoma medications reduction, and complications were analyzed at day 90 post-treatment. Primary success criterion consisted of eyes with a postoperative IOP ≤ 22 mmHg or a 30% reduction of pre-treatment IOP and managed with topical anti-glaucoma medications only.
RESULTS : A total of 68 eyes from 67 patients were included for analysis: 30 in the pop-titrated group and 38 in the fixed-energy group. Therapeutic success was achieved in 56-72% of the pop-titrated group versus 47-52% in the fixed-energy group considering the 3 different criteria analyzed (p = 0.23-0.4). There was a 22% (from 4.1 to 3.2 drugs) reduction of anti-glaucoma medications in the pop-titrated group, compared to 32% (from 3.5 to 2.4 drugs) in the fixed-energy group (p = 0.42). Five eyes (13.1%) developed hypotony, all of which belonged to the fixed-energy group (p = 0.048).
CONCLUSIONS : Pop-titrated DLTSC represents an effective and safe option for the management of refractory glaucoma. We found no statistically significant difference in success rates among both groups. However, there was a significantly higher risk of hypotony in eyes treated with the fixed-energy protocol.


Cyclophotocoagulation,Diode laser,Hypotony,Intraocular pressure,Refractory glaucoma,