Endoscopic laser coagulation of the ciliary processes in patients with severe chronic glaucoma.

BACKGROUND: To investigate the effect of endoscopic laser coagulation on the ciliary processes in order to control intraocular pressure (IOP) in patients with severe chronic glaucoma.

PATIENTS AND METHODS: 6 eyes (5 pseudophakic, 1 phakic) of 5 patients (mean age 60 years, range 46 - 70) were treated. Glaucoma was related to previous detachment surgery (patients 1), panuveitis (patient 2), iris dystrophy (patient 3), or neovascularization (patient 4: central venous occlusion; patient 5: proliferative diabetic retinopathy). Preoperatively, all patients had not responded to intensive glaucomatous topical and systemic treatment (mean 4.2 drugs, range 3 - 5). Trabeculectomy has been unsuccessfully performed in patients 2 and 3. After pars plana vitrectomy, the ciliary processes were coagulated under endoscopic view over 180 - 270 degrees using endolaser (argon green with spots of 300 - 500 mW for 0.4 - 0.5 s). Patient 5 was treated in both eyes.

RESULTS: The mean preoperative IOP was 39 mm Hg (range 32 - 47). The mean postoperative follow-up was 339 days (range 125 - 485). The postoperative IOP was over 1 year under 21 mm Hg in patient 1 with one topical drug, and in patients 2 and 3 without any further treatment. Patient 4 needed trabeculectomy and one topical drug to control IOP. The IOP was not controlled in patient 5 with the shortest follow-up despite additional topical treatment. No serious treatment-related complication was noted.

CONCLUSIONS: Endoscopic laser coagulation allows a precise destruction of the ciliary processes, and permits a better control of IOP in certain cases of severe chronic glaucoma. Further investigations are necessary to better evaluate this therapy.