الفهرس 
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Abstract
This study aimed to assess the efficacy, safety, and possible complications of the diode laser cyclophotocoagulation procedure to reduce IOP and relieve pain in adult patients with refractory glaucoma.
Fifty-four eyes of 54 consecutive patients with refractory glaucoma, defined as uncontrolled intraocular pressure (IOP) with evidence of optic nerve damage and/or visual field deterioration despite maximally tolerated topical and/or systemic anti-glaucoma medications, failed surgical treatment or a combination of surgery and medications, or a high risk of failure of trabeculectomy. They were subjected to continuous wave transscleral diode laser cyclophotocoagulation (CW-TSCPC), and were observed for six months after the procedure.
All patients were subjected to preoperative evaluation including history taking : data collected include age, sex, main symptoms, subjective assessment of the severity of pain using the Verbal analogue scale (VAS), history of any systemic diseases, history of eye trauma, history of previous eye surgeries and history of any topical or systemic medications and ophthalmological evaluation was done including : uncorrected distant visual acuity, best-corrected distant visual acuity were measured with the Snellen chart and converted to logMAR value, slit-lamp biomicroscopy, Intraocular pressure (IOP) measured by Goldmann applanation tonometry, and Fundus examination by + 90.0 diopter lens in eyes without dense cataract. When fundoscopy was not possible, the posterior segment was evaluated with B-scan ultrasonography. The number of ocular hypotensive medications being taken by each patient was assessed prior to surgery.
Post operative follow up included : uncorrected distant visual acuity, best-corrected visual acuity were measured with the Snellen chart and converted to logMAR value., slit-lamp biomicroscopy, Intraocular pressure (IOP) measured by Goldmann applanation tonometry, number of ocular hypotensive medications needed to maintain a stable IOP, Postoperative pain grading using the VAS, and post-operative complications.
Our results revealed a high statistically significant difference (p <0.0001) between pre-operative and post-operative IOP, number of medications, and grading of pain during the whole follow up visits. Moreover, there was a high statistically significant improvement in the mean BCVA in 22 (40.7%) patients before and 6 months after the procedure, from 1.90±0.26 logMAR (range 2.3-1.47 logMAR) to 1.59±0.42 logMAR (range 2.3-1 logMAR) with a P value =0.0002.
In our study, we recorded three cases (5.56%) of transient hypotony (IOP < 5 mmHg), who presented 7:30 days after initial treatment, one patient with uveitic glaucoma presented with intraocular inflammation and a mild anterior chamber reaction at the 1 month follow-up visit, and one patient showed visual deterioration from 1.85 logMAR to 2.30 logMAR.
Conclusion:
The present study demonstrated an alternative method regarding the use of diode laser trans-scleral cyclophotocoagulation in the treatment of refractory glaucoma. Encouraging results regarding IOP control and the reduction of the number of antiglaucoma medications were obtained with relatively few transient complications and without additional expenses to the patients. Diagnostic category seems to influence postoperative course and outcome stronger than laser protocol and delivered energy. Post-vitrectomy glaucoma, NVG, and congenital glaucoma tend to be less responsive to cyclodiode treatment.