Diode Laser Trans – Scleral Cyclo – ablation as a Primary Surgical Treatment for Primary Open – Angle Glaucoma after Maximum Tolerated Medical Therapy

Introduction: The incidence rate and prevalence of glaucoma in Pakistan is similar to that of other dark - colored population countries. Primary trabeculectomy is still a preferred surgical approach. Diode laser is widely accepted as the therapy of choice in severe glaucoma cases. The purpose of this study was to determine the role of Diode Laser Transscleral Cyclo-ablation as a primary surgical treatment option in Primary Open Angle Glaucoma after maximum tolerated medical therapy.Methods: This quasi - experimental study was conducted at Layton Rahmatullah Benevolent Trust Free Eye Care and Cancer Hospital, Lahore. Sixty patients fulfilling the inclusion criteria were selected from the Glaucoma unit for this study. 25 - 30 burns of Diode Laser were applied to 270 degrees avoiding 3 and 9 o clock positions, 1.5 mm posterior to the limbus. Laser was set at duration of 1 second and power between 1000 and 1500 mw. Patients were followed up for a period of one year.Results: Out of a total of 60 eyes with mean age 52.73 ± 7.40 years, 36 (60%) were male and 24 (40%) were female. The mean pre-operative Intra Ocular Pressure IOP was 41.0 ± 7.0 mmHg (The pre-operative IOP ranged from 28 mmHg to 60 mmHg). The mean post-operative IOP was 18.97 mmHg on day one, 16.75 mmHg at 1 week, 15.68 mmHg at 1 month, 15.00 mmHg at 6 months and by the end of a year it was about 14.15 mmHg (The post-operative IOP ran-ged from 6 mmHg to 52 mmHg). There was a significant drop of more than 50% of post-operative IOP as compared to pre-operative IOP.Conclusion: Diode Laser Transscleral Cycloablation is a practical, rapid, well - tolerated procedure that provides a significant lowering of intraocular pressure with few complications and can considered as alternative treatment in POAG if medical therapy fails