Endoscopic Diode-Laser Cyclophotocoagulation in the Management of Aphakic and Pseudophakic Glaucoma

Abstract

Introduction: Endoscopic cyclophotocoagulation (ECP) has been shown to be a useful adjunct in the management of a variety of pediatric glaucomas. This study reports the efficacy and safety of this procedure for aphakic glaucoma. Methods: The charts were reviewed of all children under age 16 years who underwent ECP for aphakic glaucoma between April 1994 and November 2004. Endocyclophotoablation was performed with the Microprobe (Endo Optiks, Little Silver, NJ) integrated laser endoscope system on 36 eyes of 26 patients. Patients were followed for a minimum of 12 months or until a treatment failure had been declared. Treatment failure was defined as postoperative intraocular pressure (IOP) of >24 mm Hg despite the addition of glaucoma medications or the occurrence of any visually significant complications. Aphakic eyes of patients with congenital glaucoma or an anterior segment dysgenesis were not included in the study group. Results: Mean follow-up period for study eyes was 42.4 months (range 0.17 to 129.3 months). Pretreatment IOP averaged 33.3 mm Hg in the 36 eyes, compared to a final postoperative average of 23.2 mm Hg. The average number of procedures per eye was 1.5. The mean arc of treatment on the first procedure was 229 degrees, while cumulative degrees of treatment at the study’s conclusion were 267 degrees. Overall success rate was 58% (21/36). Fifteen of 22 eyes (68%) that received one treatment only were deemed a success. A total of 39% (14/36) of eyes underwent further ECP. Significant complications occurred in two eyes that developed retinal detachments within the first postoperative month. Conclusions: Endocyclophotocoagulation is a useful tool in the treatment of aphakic glaucoma, with a low rate of visually significant complications. Retreatment of eyes did not significantly improve the overall success rate, nor did it increase the incidence of complications such as hypotony.