Original Articles
A clinical comparison of transscleral cyclophotocoagulation with neodymium: YAG and semiconductor diode lasers

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Abstract

PURPOSE: To compare the efficacy of transscleral cyclophotocoagulation using a neodymium: YAG (Nd:YAG) or semiconductor diode laser in controlling intraocular pressure in patients with refractory glaucoma.

METHODS: In a prospective study, 95 eyes of 91 patients with refractory glaucoma randomly received Nd:YAG or diode cyclophotocoagulation. Patients were followed for a mean of 10.4 months (10.42 ± 3.16, mean ± SD). We compared available data preoperatively and at 1 week, 1 month, 6 months, and 12 months postoperatively. Data analyzed were corrected visual acuity, intraocular pressure, and the type of glaucoma.

RESULTS: There was a statistically significant decrease in intraocular pressure after both Nd:YAG and diode cyclophotocoagulation at each time period. However, there were no significant differences in postoperative intraocular pressure or visual acuity change between Nd:YAG and diode procedures.

CONCLUSIONS: Compared with the Nd:YAG laser for transscleral cyclophotocoagulation, the diode laser has technological advantages including portability, durability, and smaller size, while providing equivalent postoperative intraocular pressure and visual acuity change.

Section snippets

Methods

In a prospective study, noncontact continuous wave Nd:YAG or semiconductor diode transscleral cyclophotocoagulation was randomly assigned to 95 eyes of 91 consecutive patients with medically uncontrolled glaucoma for which conventional surgical approaches had failed or were believed to have a poor likelihood of success. All patients signed an informed consent for this laser procedure after an explanation of the risks and benefits. Patients were followed for a mean of 10.4 months (10.42 ± 3.16

Results

Ninety-five eyes of 91 patients with refractory glaucoma were randomly assigned to receive Nd:YAG or diode cyclophotocoagulation. Patient demographics are shown in Table 1. There were 51 men and 44 women with a mean age of 65.7 years (range, 21 to 92 years). Fifty-eight patients were white and 37 were black. There were no statistically significant differences in gender, race, and age between the Nd:YAG and diode laser groups (P = .5350, .4278, and .7698, respectively). The most common types of

Discussion

Transscleral Nd:YAG cyclophotocoagulation has become the cyclodestructive procedure of choice for the management of refractory glaucoma. In spite of many advantages, the use of Nd:YAG cyclophotocoagulation has been limited because of postoperative complications, especially loss of visual acuity and excessive inflammation1, 2, 3, 4, 5, 6, 7, 8, 14 and possibly sympathetic ophthalmia.15, 16, 17

The semiconductor diode laser has certain technological and potential biological advantages over Nd:YAG

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