Diode Laser Cyclophotocoagulation in Refractory Glaucoma: Comparison Between Pediatric and Adult Glaucomas

Abstract

* OBJECTIVE: To evaluate the outcome of contact transscleral diode laser cyclophotocoagulation (CTDC) in eyes with advanced glaucoma and to compare the efficacy in pediatric and adult patients. * PATIENTS AND METHODS: Included in the study were 4 1 eyes (39 patients) with advanced glaucoma ( 1 5 eyes of 1 3 pediatric patients and 26 eyes of 26 adult patients). The patients were followed at least for six months or until failure of the procedure, if shorter than 6 months. The mean follow-up of all patients was 10 months (median 8 months, range 324 months); the mean pretreatment intraocular pressure (IOP) was 34.5 ±10.9 mm Hg for all cases, 36.2±12.6 mm Hg in adult cases and 31.6±6.5 mm Hg in pediatric cases * RESULTS: At last follow-up after first treatment, there was significant decrease in IOP and the mean reduction in IOP was 12.11 ±10.5 mm Hg for all eyes. The mean reduction in IOP adult (13.6±11.8 mm Hg) and (9.9±6.8 mm Hg) patients. While the success rate after the first diode laser therapy was 59%, it increased to 75% after retreatments. The most common complications were conjunctival hyperemia and anterior chamber reaction. There was no difference in the complication rate between the pediatric and adult cases. * CONCLUSION: CTDC is a safe and effective therapy in eyes with advanced refractory glaucoma in the short term. But multiple applications may be needed in the long term. The results in adult and pediatric patients were found to be similar in efficacy and safety. [Ophthalmic Surg Lasers 2001;32:100-107]

Proliferative Vitreoretinopathy Following Transscleral Diode Cyclophotocoagulation

“…14 The settings used in pediatric cyclodiode procedures also vary greatly in the literature. Izgi et al 15 ). These results may indicate a dose-response relationship between delivered cyclodiode energy and complication rates, and utilizing a lower power or number of treatment spots may avoid the retinal complications reported in our patient.…”

“…The settings used in pediatric cyclodiode procedures also vary greatly in the literature. Izgi et al15 delivered total energy of 70 J (mean 1850 mW ×2000 ms × 19 shots × 270 deg), with a 59% success rate (IOP<22 mm Hg at 7 mo), and reported no serious complications, including retinal detachment. Similarly, Sakaorat et al1 reported no retinal or choroidal detachment complications in a cohort of 59 eyes (mean age 2.7 y) after delivering a lower total energy of 58 J (mean 1254 mW × 1545 ms × 30 shots × 270 deg); however, their success rate was slightly lower at 46.67% 1 year following cyclodiode.…”

Diode Laser Transscleral Cyclophotocoagulation With a Novel Low-Cost Torchlight Method of Trans-Corneal Transillumination in Refractory Pediatric Glaucoma

“…When surgery fails, cyclophotocoagulation often remains a viable, relatively non-invasive modality to minimize the risks of repeated surgery in these eyes. 9,12,13 The biggest challenge for transscleral cyclophotocoagulation is the lack of predictability due to the difficulty in assessing the location of the target tissue. In children, this is compounded by the enlarged globe and distorted limbal anatomy due to the stretching due to the raised IOP.…”

“…Cyclodestruction is used increasingly as a viable treatment modality for intractable childhood glaucoma. 12,13 The major limitation of transscleral diode laser cyclophotocoagulation (TSCPC) diode laser transscleral cyclophotocoagulation is its lack of predictability. One of the reasons may be the imprecise treatment of the ciliary processes owing to the distorted limbal anatomy, especially in children with glaucoma.…”

“…Cyclodestruction is used increasingly as a viable treatment modality for intractable childhood glaucoma 12,13 . The major limitation of transscleral diode laser cyclophotocoagulation (TSCPC) diode laser transscleral cyclophotocoagulation is its lack of predictability.…”