Trans-scleral diode laser cyclophoto-coagulation in the treatment of diabetic neovascular glaucoma

Aims To assess efficacy of trans-scleral diode laser cyclophotocoagulation in the treatment of diabetic neovascular glaucoma refractory to medical therapy. Methods Case notes of 20 eyes of 20 patients who had the treatment were analysed. The mean follow-up after initial treatment was 22.5 months (range of 18–24). Results Mean (SD) pretreatment intraocular pressure (IOP) for the 20 eyes was 34.4 mmHg (9.5) reducing to 18.2 mmHg (12.4) at the final index visit ( P =0.0001). The mean (SD) number of topical antiglaucoma medication was significantly lowered from 3.9 (0.3) to 1.2 (1.3). Four patients had visual acuity of 6/60 or better before the treatment. Two of them maintained the same level of vision and the other two had their vision reduced over the course of study; however, none of them deteriorated beyond 6/60. Six out of the remaining 16 patients who had vision of counting fingers or worse before treatment progressed to no perception of light at the final index visit. The mean (SD) number of treatment sessions was 1.45 (0.68). A total of 10 patients had previous pars plana vitrectomy (PPV). Patients with two or more PPVs developed hypotony (IOP ≤5). There were five eyes with hypotony, one of which became phthisical. Conclusion Trans-scleral diode laser cyclophotocoagulation is a useful tool in the management of diabetic neovascular glaucoma. The current treatment regime needs to be adjusted to reflect higher risk of hypotony and phthisis in diabetic neovascular glaucoma in eyes that have had multiple pars plana vitrectomies.