Endocyclophotocoagulation for management of difficult pediatric glaucomas

Abstract

Introduction: Experience with endoscopic diode laser cyclophotocoagulation remains limited. We report the efficacy and safety profile of this glaucoma surgery technique in the pediatric population. Methods: Retrospective review of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Surgery was performed by using the Microprobe (Endo Optiks, Little Silver, NJ) integrated laser endoscope system. Patients were followed-up for a minimum of 6 months or until declared treatment failures. Treatment success is defined as a postoperative intraocular pressure of ≤ 21 mm Hg, with or without adjunctive glaucoma medications. Results: Baseline mean pretreatment intraocular pressure was 35.06 ± 8.55 mm Hg. Final postoperative intraocular pressure was 23.63 ± 11.07 mm Hg (30% decrease) after an average of 1.42 ± 0.87 endolaser procedures and 19.25 ± 19.36 months of follow-up. Success rate of the initial procedure at last follow-up was 34%. Nine eyes (25%) were retreated at least once. Cumulative success rate after all procedures at last follow-up was 43%. Mean cumulative arc of treatment was 260° ± 58° of ciliary processes. Postoperative complications included retinal detachment in 2 patients, hypotony in 1 patient, and progression of vision loss from hand motion to no light perception in 1 patient. All 4 complications occurred in aphakic patients. Conclusions: Endoscopic diode laser cyclophotocoagulation is a moderately effective procedure for the management of difficult pediatric glaucomas. Aphakic patients may have an increased risk of significant postoperative complications, such as retinal detachment. (J AAPOS 2001;5:221-9)