Contact transcleral ciliary body photodynamic treatment with verteporfin in cases of refractory glaucoma

Purpose Previous animal studies showed that contact transcleral ciliary body photodynamic treatment with verteporfin is a safe procedure for temporarily reducing IOP. The purpose of this study is to investigate safety and efficacy in cases of refractory or absolute glaucoma. Methods 8 patients, 8 blind painful eyes of with absolute glaucoma (6 neovascular, 1 Sil Oil, 1 refractory), with mean IOP 37±12 mmHg, were treated. Verteporfin bolus infusion of 6 mg/m^2 body surface area over 1 minute was done prior to irradiation, realized with a triple optic fiber connected to a 689nm diode laser. Energy at each fiber’s tip was 80mW and irradiation time 3min per spot. 12 spots over 360 degrees (12min) were done. Eye drops with dexamethasone and tobramycin qd for 4 days were prescribed. Follow up consisted of daily slit lamp examination and IOP measurements with Goldman Tonometer during the first week, then weekly during the first month, then monthly. Photography was used to document clinical findings. Results Significant mean IOP reduction of 25% for 2 weeks was observed in all cases. IOP returned to pre‐treatment values during the third week in 4 cases, during the 2nd month in 2 cases and 3rd month in 2 cases. Conjunctival oedema and anterior chamber reaction were mild and lasted 24‐48 hours. No serious adverse events were observed and patient’s discomfort was limited. Conclusion Our findings suggest that contact transcleral ciliary body photodynamic treatment with verteporfin with the above mentioned settings is safe and efficient in short term in cases of refractory or absolute glaucoma.