Endoscopic cyclophotocoagulation (ECP) for childhood glaucoma: a large single-center cohort experience

Abstract

To assess the factors associated with successful outcomes in the management of childhood glaucoma treated with endoscopic cyclophotocoagulation (ECP) as both primary and adjunctive surgery. The medical records of consecutive children with glaucoma treated by a single surgeon at a single center over a 17-year period using ECP procedures were reviewed retrospectively. Treatment failure was defined as (1) intraocular pressure (IOP) >24mm Hg at two consecutive examinations despite maximal medical treatment, (2) any additional glaucoma surgery, (3) sight-threatening complications, or (4) progression to no light perception visual acuity. Success was defined as the absence of treatment failure. A total of 107 ECP procedures on 80 eyes of 70 children were included. Glaucoma diagnoses included: following-cataract-surgery (60%), anterior segment dysgenesis (13%), primary congenital (9%), and other (19%). Most eyes (67 [84%]) had prior glaucoma surgery, and 73 (91%) were aphakic or pseudophakic at first ECP. Median follow-up was 2.2years (IQR, 1.1-3.5) after initial ECP; mean number of ECP treatments per eye was 1.3 (range, 1-3). Success for a single ECP treatment at 1, 3, and 5years (Kaplan-Meier analysis) was 64% (95% CI, 54-76), 36% (26-50), and 16% (7-37), respectively. Cumulative success (≥1 ECP) at 5years was 34% (23-50). In multivariable analysis, of many risk factors considered, only a preoperative IOP of <32mm Hg was significantly associated with treatment success. ECP represents a modestly effective long-term therapy for childhood glaucoma and may be most successful in patients with preoperative IOP of <32mm Hg.