الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Refractory glaucoma is the term used for glaucoma resistant to conventional management. This includes maximally tolerated medical therapy, one or more than one glaucoma surgeries with or without antimetabolites and in cases of rubeotic glaucoma after panretinal photocoagulation or cryoablation.
Cyclodestructive procedures are used when glaucoma becomes resistant to conventional medical and surgical procedures. These procedures destroy the non pigmented and pigmented epithelium of the ciliary body leading to decrease in aqueous production and thus DROP in intraocular pressure. Contact Diode laser cryoablation is emerging as the preferred treatment because there is less risk of hypotony and phthisis.
The ciliary body is the site of aqueous humor production and it is totally involved in aqueous humor dynamics. The ciliary body is the anterior portion of the uveal tract, which is located between the iris and the choroid
We conducted a prospective interventional non comparative non randomized case series on 20 eyes of patients attending Minia University Hospital outpatient clinic from November 2014 to July 2015 .
The procedure was recommended to preserve residual vision or relieve pain in patients who had been found refractory to maximum tolerable medical therapy and surgery or alternative laser treatments.
Data were collected about patient, diagnosis, glaucoma medication, intraocular pressure (IOP) course, complications, visual acuity and laser parameters.
The procerure was done in the operating room. Treatment was conducted under local (retrobulbar injection of 3.5 ml of 20% mepivacain) or short general anaesthesia and after insertion of a lid speculum and disinfection with bovidine iodine.The treatment was done using the continuous-wave semiconductor diode laser (810 nm) and the fibre-optic Iris G-probe (OcuLight SLx, IRIS Medical Instruments, Mountain View, CA)(USA).
All analysis was done by using SPSS, version 20.
There were 12 female and 8 male patients in the study and the mean age was 34 ± 15 years. The mean follow up was 6 months (range 4-8 months).
None of the patients in this study had had previous cyclodestructive procedure in the affected eye. Based on age the patients were divided into two groups – less than 40 years (6patients) and more than or equal to 40 years (14 patients). In the former group 3 patients required retreatment. In the later group, 5 patients needed retreatment.
The mean baseline IOP was 44.6 ± 7.3 mmHg. 12eyes had IOP > 44 mmHg and 8eyes had IOP not more than 44 mmHg; retreatment was needed in 4 eyes with IOP > 44 mmHg and 4 eyes with IOP 44 mmHg. The IOP was controlled at <22 mmHg in 12(60%) eyes (with or without treatment) during the first week of follow up.
Of these, 8 patients did not require any medication, 2patients were controlled on topical timolol maleate 0.5% alone and 2 were controlled on combination of topical timolol 0.5% and pilocarpine 2%. The remaining 8 patients(40%) will need another session. 8 eyes (42%) required retreatment two times in 4 eyes, three times in 3 eyes, and four times in 1 eyes. In 6 of the 8 retreated eyes, IOP was <22 mmHg at their last follow up, but in 2 eyes IOP remained uncontrolled.
Histologic studies of eyes with failed cyclodiode after a single treatment have been attributed to preservation of some ciliary processes though reversal of laser induced increase in uveoscleral outflow has also been postulated to explain the rise of IOP after failed cyclodiode therapy.
18 applications of cyclodiode over 270° with 3-4 J energy per spot were effective in lowering IOP and relieving pain in refractory glaucoma. But the need for retreatment was high(40%). This study also confirms the relative safety of diode laser cycloablation in patients. We recommend further studies to evaluate the role of cyclodiode in glaucomatous eyes with better visual prognosis & longer follow up & larger sample size.