Long-Term Results of Transscleral Cyclophotocoagulation in Refractory Pediatric Glaucoma Patients

Abstract

We evaluated efficacy and complications of diode laser cyclophotocoagulation in pediatric patients with refractory glaucomas. The retrospective study comprised 69 eyes of 53 pediatric patients with uncontrolled refractory glaucoma treated by transscleral diode laser cyclophotocoagulation. The mean age was 6.1 ± 4.29 (range 0.9–15) years. The main parameters evaluated were: intraocular pressure (IOP), visual acuity, and complications. The mean follow-up period was 5.6 ± 2.8 (range 2.2–9.5) years. Treatment success was defined as a postoperative IOP of ≤21 mm Hg, with or without adjunctive glaucoma medications. The baseline mean pretreatment IOP was 34.08 ± 7.13 (range 24–47) mm Hg. The final mean postoperative IOP was 20.81 ± 6.38 (range12–33) mm Hg after a mean of 2.13 ± 1.47 (range 1–6) laser procedures. After one treatment session, 66% of the eyes had a successful reduction in IOP (≤21 mm Hg), but this had fallen to 41% by 1 year. With repeat cyclophotocoagulation, 79% of the eyes had a clinically effective reduction in IOP(≤21 mm Hg) for 1 year (mean 7.1-month interval between treatments). Postoperative complications included choroidal detachment in 4 eyes and retinal detachment in 2 eyes with progression of vision loss. All these complications occurred in aphakic patients. Cyclophotocoagulation by diode laser is a useful therapy for the treatment of refractory pediatric glaucomas with uncontrolled IOP. Cyclodiode repeated treatment can provide effective control of IOP with a low risk of severe complications. Aphakic patients may have an increased risk of postoperative complications.

Advances in the management of congenital and infantile cataract

“…48 Cyclodestructive procedures have been used, but in many cases, the pressure lowering effect appears only temporary 49 and there may be a greater risk of complications in aphakic patients. 50 Greater long-term success in controlling intraocular pressure has been achieved with the implantation of drainage tube devices such as the Ahmed Valve 51 ( Figure 2) or Baerveldt implant. 52 Sometimes diode laser cycloablation is necessary to temporarily lower intraocular pressure and reduce the risk of perioperative suprachoroidal haemorrhage while undertaking drainage tube surgery.…”

Silikon Emülsifikasyonuna Bağlı Kontrol Edilemeyen Göz İçi Basıncı Yüksekliğinde Transskleral Diod Lazer Siklofotokoagülasyon

“…26 The complications after TDCP include conjunctival burns, pain, vision loss, hyphema, uveitis, cataract progression, hypotony, choroidal detachment, and phthisis. 12,26,[28][29][30] In our study, the main complication was transient pain in 9 eyes. However, no serious complications such as inflammation and phthisis occurred.…”

Childhood glaucoma surgery in the 21st Century

“…Complications associated with diode laser include: hypotony, significant uveitis, phthisis, conjunctival burns, uveitis, scleromalacia, scleral perforation, cataract, retinal detachment, and loss of vision especially in eyes with two or more treatments or in eyes with pre-existing poor vision. 122,[125][126][127][128] Short-to-medium term outcomes of transscleral diode laser quote over 50% success but with a high retreatment rate and a continuation of medical therapy. 127,128 Endoscopic diode achieves similar results with a lower re-treatment rate.…”

“…122,[125][126][127][128] Short-to-medium term outcomes of transscleral diode laser quote over 50% success but with a high retreatment rate and a continuation of medical therapy. 127,128 Endoscopic diode achieves similar results with a lower re-treatment rate. 124,129,130 Our preference is to use transscleral diode laser with transillumination of the eye to improve the accuracy of laser placement, and we avoid areas of pigmentation, haemorrhage, and scleral thinning.…”