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

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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 (range 12-33) 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.