Purpose: To evaluate the success of contact transscleral cyclophotocoagulation (TDC) in patients with refractory pediatric glaucomas. Methods: Twenty-six eyes of 20 patients with therapyresistant pediatric glaucomas were included in this retrospective study. Subgroup analysis was performed for patients 10 or younger and patients older than 10 at time of first TDC procedure. Diode laser cyclophotocoagulation was applied using a fiber optic G-probe. Follow up until time of failure or for a minimum of 6 months was obtained for all procedures in all eyes. Failure was defined as intraocular pressure (IOP) greater than 21 mm Hg, repeat of TDC due to clinically inadequate IOP control, progression to another procedure, or serious complication. Results: Baseline mean pretreatment IOP was 34.2 ± 10.4 mm Hg (range, 15 to 62 mm Hg). Ten of 26 eyes (38%) were successful 6 months after initial TDC. A mean decrease in IOP of 10.3 ± 14.7 mm Hg was noted after the first procedure (F<0.05). Eighteen eyes (70%) were retreated at least once. The mean decrease in IOP for all patients after all procedures was 12.9 ± 13.4 mm Hg (P<0.001). This represents a mean percent decrease in IOP of 33.2 ± 6.9%. The overall success rate was 50%, including retreated patients. The younger and older subgroups did not differ with regard to overall success, time to failure, or retreatment rate. One patient suffered a retinal detachment. Visual loss was noted in 4 of 22 eyes with reliable visual acuity measurements. Conclusion: TDC is an effective means of decreasing IOP in some patients with refractory pediatric glaucomas. Although the retreatment rate is high, the procedure generally is well tolerated with few complications.

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Transscleral neodymium:yttrium-aluminum-garnet (Nd:YAG) laser cyclophotocoagulation (TSNYC) is used to lower intraocular pressure (IOP) in glaucoma patients refractory to conventional medical and surgical therapy. Our study investigates the ability of TSNYC to lower IOP in normal cats. One eye of 13 cats was treated with non-contact TSNYC. Mean pretreatment IOP was 25 mm Hg (vs. 25.3 mm Hg in contralateral control eyes). Eyes received 80 laser applications over 360 degrees delivered at least 3 mm posterior to the limbus with maximum power (8 to 9 joules) and maximum retrofocus (3.6 mm). Eyes were retreated if IOP was not reduced below baseline after 2 weeks. By 4 weeks, IOP was decreased in all treated eyes by a mean of 29.2% and was maintained as long as 20 weeks (mean decrease 14.8%). IOP in 10 eyes was lowered after a single treatment session. Of these, 2 eyes had IOP spikes > 10 mm Hg prior to IOP reduction. Three cats required retreatment to maintain IOP reduction. All eyes developed transient (< 4 weeks) postoperative uveitis and 3 eyes developed rubeosis iridis which resolved with topical corticosteroids. Histologic examination (6 weeks post-treatment) showed focal disruption of the pigment epithelium and to a lesser degree the nonpigmented epithelium at the base of the ciliary body and in the valleys of the pars ciliaris. The epithelium at the apices of the ciliary processes appeared intact. Vascular engorgement was variably present. This study demonstrates that TSNYC lowers IOP in cats. This animal model will be useful for investigating mechanism(s) responsible for TSNYC-induced IOP reduction.

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