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BioMed Research International
Volume 2013 (2013), Article ID 371951, 11 pages
http://dx.doi.org/10.1155/2013/371951
Research Article

A Comparison between Tube Surgery, ND:YAG Laser and Diode Laser Cyclophotocoagulation in the Management of Refractory Glaucoma

1Western Eye Hospital, 153-173 Marylebone Road, London NW1 5QH, UK
2Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia
3Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
4Department of Ophthalmology, The American University of Beirut Medical Center, Beirut 113-6044, Lebanon
5Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK

Received 3 April 2013; Accepted 22 August 2013

Academic Editor: Susmito Biswas

Copyright © 2013 Philip A. Bloom et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. To compare the results of intraocular pressure (IOP) reduction by 3 treatment modalities, (a) glaucoma tube implants, (b) noncontact YAG laser cyclophotocoagulation (cycloYAG), and (c) contact transscleral diode laser cyclophotocoagulation (cyclodiode), in cases of advanced glaucoma refractory to alternative treatments. Methods. A consecutive group of 45 eyes that received cycloYAG were matched against two control groups of patients who had received tube surgery or cyclodiode, each control group having been derived from a database of patients. Results. Mean pretreatment IOP improved from 41.3, 38.6, and 32.0 mmHg for the tube, cycloYAG, and cyclodiode groups, respectively, to 16.4, 22.1, and 19.3 mmHg, respectively. Treatment success was achieved in 78%, 69%, and 71% of the tube, cycloYAG, and cyclodiode groups, respectively. Visual acuity deteriorated 2 or more Snellen lines in 16%, 7%, and 9% of the patients in the tube, cycloYAG, and cyclodiode groups, respectively. Complications included retinal detachment, hypotony, and phthisis. Conclusions. All 3 methods provided acceptable IOP lowering in the short and medium term. Control of IOP was best in patients receiving tube surgery. Cyclodiode and cycloYAG treatments were similarly effective in lowering IOP. Tube surgery was associated with a greater incidence of sight threatening complications.