Short-term Efficacy and Safety Outcome of Primary Trans Scleral Diode Laser Cyclophotocoagulation for Primary and Secondary Glaucoma in Nigeria: A Prospective Study

Abstract

Glaucoma care in Africa is difficult due to various problems associated with its treatment. These include late presentation, poor acceptance of surgery deemed to be the best option for advanced glaucoma, and poor adherence and persistence with medications. There is therefore a need for an alternative treatment that is effective and also acceptable to patients. Trans scleral diode laser cyclophotocoagulation (TDLC) appears to be a viable alternative. This study explores this possibility. Aim: To determine the efficacy and safety of TDLC as a primary treatment for various types of glaucoma in Northern Nigeria. Method: This was a prospective cohort study on 124 eyes of advanced glaucoma patients recruited consecutively, treated with TDLC using the 810 nm diode laser, and then followed up for 12 weeks. Outcome measures were percentage reduction in intraocular pressure (IOP), proportion of patients with IOP less than 20 mmHg, and proportion of eyes that lost two or more lines of visual acuity (VA). Results: Mean age was 52.4 ± 13.4 (range 18–79) years. Mean pretreatment IOP reduced from 41.8 ± 10.8 to 17.1 ± 9.9 mmHg post-treatment ( t = 19.5, P < 0.001). There was a 58% reduction in mean IOP, and 78% of treated eyes had IOP less than 20 mmHg at 12 weeks, with the lowest mean postoperative IOP seen in POAG patients. About 5% of eyes lost two or more lines of Snellen VA. Conclusion: : Findings suggest TDLC is a potentially safe and effective short-term primary treatment for patients with different types of advanced glaucoma.