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

Abstract

Précis: Transcorneal transillumination aided transscleral cyclophotocoagulation for intraocular pressure control of refractory pediatric glaucoma was found to be effective at 1 year. Purpose: To study one-year outcomes of diode laser transscleral cyclophotocoagulation (TSCPC) with trans-corneal transillumination using a novel low-cost torchlight method in refractory paediatric glaucoma. Methods: This prospective interventional study included children with refractory glaucoma who underwent TSCPC with the Oculight® laser system (IRIS Medical Instruments) with trans-corneal transillumination (TSCPC-TI) using a novel low-cost torchlight method. Children completing a minimum one-year follow-up were analyzed. They were compared to a historical control group of children who underwent TSCPC without transillumination (TSCPC-No TI) at the one-year follow-up period. We analyzed the mean laser energy delivered, post-laser intraocular pressure (IOP) reduction, number of antiglaucoma medications (AGM), the requirement of retreatment and complications of the procedure in both groups. Results: 42 eyes of 35 patients comprised the TSCPC-TI group and were compared with 31 eyes of 21 patients in the TSCPC-No TI group. The TSCPC-TI group required lower energy than the TSCPC-No TI group (24.7+7.8 J versus 47.2+10.9 J, P<0.0001). Mean topical antiglaucoma drug requirement decreased from 2.9+0.08 before treatment to 0.66±0.8 at the end of 1 year in TSCPC-TI and from 2.6+1.0 before treatment to 0.6±0.77 in the TSCPC-No TI groups respectively (P=0.15). There was a significantly reduced dependence of oral acetazolamide in the TSCPC-TI group at 1-year follow-up (5.7% vs 61.9% respectively (P<0.001%). No adverse event of hypotony or choroidal detachment was noted in any group. Conclusions: TSCPC aided by transillumination with a low-cost torchlight for pediatric refractory glaucoma was found to be effective at 1 year in reducing intraocular pressure and the burden of medication.