Long-term results of noncontact neodymium:yttrium-aluminum-garnet cyclophotocoagulation in neovascular glaucoma

Abstract

Purpose: To determine the long-term efficacy and safety of noncontact transscleral neodymium:yttrium-aluminum-garnet (Nd:YAG) cyclophotocoagulation (CP) for the treatment of neovascular glaucoma (NVG).

Design: Retrospective, noncomparative, interventional case series.

Participants: One hundred fifteen eyes of 111 subjects treated from December 1987 to January 2001.

Methods: Eyes with uncontrolled NVG underwent noncontact Nd:YAG CP. Treatment parameters and pretreatment and posttreatment intraocular pressures (IOP) were reviewed. Preoperative and postoperative IOP were compared using a paired Student's t test. Success was defined as an IOP </=22 mmHg, with or without medications, in the absence of phthisis bulbi, and without having undergone further surgical procedures. Results were subjected to a Kaplan-Meier life-table analysis.

Results: Mean follow-up was 27.0 +/- 34.3 months (range, 1-148 months). Mean preoperative IOP was 47.4 +/- 11.1 mmHg (range, 26-70 mmHg). Mean postoperative IOP was 18.3 +/- 12.2 mmHg (range, 0-44 mmHg). The mean number of treatment sessions was 1.4 +/- 0.7 (range, 1-6), with 82 eyes (71.3%) having only one treatment. Kaplan-Meier survival analysis showed a probability of continued success at 1 year of 65.0%, at 3 years of 49.8%, and at 6 years of 34.8%. Phthisis developed in 8.6% of the eyes.

Conclusions: Noncontact Nd:YAG CP provides long-term IOP reduction in eyes with medically uncontrolled NVG. This can be associated with complications that include inflammation, visual loss, and hypotony. Repeat treatment may be necessary.