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Transscleral cyclophotocoagulation in glaucoma after penetrating keratoplasty
  1. BPKIHS, Dharan, Nepal
  1. anitap49{at}

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Editor,— I read the article by Schloteet al 1 with interest. The aim of their study was to determine the safety and effectiveness of transscleral diode laser cyclophotocoagulation (TDLC) in post inflammatory eyes with refractory glaucoma. In addition, the authors have rightly pointed out that management of inflammatory glaucoma is still a dilemma as many of the antiglaucoma drugs are either contraindicated or ineffective in such eyes. Further, some surgical procedures may activate the inflammatory diseases. I congratulate Schlote et al for highlighting the efficacy of TDLC in inflammatory glaucoma. In this context I would like to share our experience in one group of such eyes, “post-PK glaucoma.”

Glaucoma following penetrating keratoplasty continues to be a serious problem because of the frequency of its occurrence, its recalcitrant nature, and the risk of further damaging an already compromised anterior segment. We found in our study of eight eyes with uncontrolled post-PK glaucoma (Table 1) that all the eight eyes responded to the therapy and the mean IOP was 17.5+1.06 at the end of 24 weeks post-TDLC where the preoperative average intraocular pressure was 32.5 (SD 3.66) mm Hg. All but one patient were off systemic antiglaucoma therapy at 6 months. However, all the patients were taking topical timolol maleate 0.5% twice daily. The graft clarity was improved by 1+ in four eyes and 2+ in one.2 In three eyes the graft clarity was worsened. Visual acuity was static in six eyes and improved in one. In one eye the visual acuity was reduced from 3/60 to counting fingers. On the basis of the reports by Schlote et al 1 in 2000 and Spencer and Vernon3 in 1999, we believe that TDLC is an alternative to treat post-PK glaucoma.

However, considering the non-improvement of visual acuity, worsening of the graft clarity in 25% of eyes, and repeat therapy in 25% of eyes, our question remained unanswered about the real efficacy of the procedure. It is, therefore, essential to know from the authors about the efficacy of TDLC in post-PK glaucoma. Once again I congratulate the authors for bringing up this important issue.1 ,2