Efficacy of Transcleral Diode Cyclophotocoagulation in a sub-Saharan Rural Population with Severe Glaucomatous Ocular Hypertension

Document Type


Publication Date


Journal Title

Investigative Ophthalmology & Visual Science




Purpose : Gross elevation of intraocular pressure in patients with end stage glaucoma can be accompanied by chronic frontal headache, stabbing eye pain, and autonomic side effects including hyperhidrosis, indigestion, nausea, and cardiac arrhythmia. Topical antiglaucoma medications in rural sub-Saharan Africa are typically reserved for treatment of patients with survival of reading vision. This study assesses the efficacy of trans-scleral diode cyclodestruction in eyes of Malawian adult patients with uncontrolled ocular hypertension and BCVA of HM or worse.

Methods : Consenting adult patients with end-stage glaucoma and uncontrolled ocular hypertension were treated ab externo with Iridex SLx 810 diodle laser via G-probe after placement of retrobulbar lidocaine under IRB-approved protocol. Applanation IOP at each visit was measured independently by 2 clinicians, and their readings averaged. IOP Change from baseline at each time interval was assessed by paired t-test.

Results : 40 eyes of 33 patients (28M,5F; mean age 60) were treated. A mean of 19 spots were placed (+/-sem0.6) at a mean setting of 2059(+/-162)mW. Mean pre-treatment IOP was 38.1(+/-1.9)mmHg. Post-treatment IOP values at 1, 2 and 4 months were 24.3(+/-1.7), 22.8(+/-1.6) and 19.1(+/-1.1)mmHg, respectively (P<0.00001 for all three intervals). Visual acuity was not significantly altered (2 eyes improved, all others stable), but symptomatic relief was reported by a majority of those undergoing diode laser treatment. No significant complications were encountered.

Conclusions : Mean intraocular pressure was decreased by 36%, 40%, and 50% at one, two and four months after trans-scleral diode cyclophotocagulation, achieving normal mean IOP level by 4 months without additional therapy. The diode treatments fit well into the clinical routine, and these very encouraging results with standard trans-scleral diode in end-stage patients has motivated us to move forward with a similar prospective program of micropulse diode cyclophotooagulation for patients with moderate to severe glaucoma.


This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

Figure (1).ppt (466 kB)
Intraocular pressure response to diode cyclophotocoagulation among rural Malawian adults with end stage glaucoma, showing decrease in IOP from a mean value approaching central retinal diastolic pressure to normal IOP level by 4 months.

Figure (2).ppt (2933 kB)
Rand Allingham of Duke University examining a patient at the Eyes of Africa Clinic, Msundwe, Malawi.