Micropulse diode laser cyclophotocoagulation in refractory pediatric glaucoma

Abstract

Aim The aim of this study was to investigate the safety and long-term efficiency of high-energy-level micropulse diode laser application in the treatment of refractory pediatric glaucoma patients. Patients and methods This is a prospective, noncomparative case series study that included 90 eyes of 90 pediatric patients with glaucoma who were refractory to surgery. Micropulse transscleral cyclophotocoagulation with a high energy level was performed in all cases. The primary outcome measure was intraocular pressure reduction, whereas the secondary outcome measures were complications, number of medications, need for repeated treatment, and number of repetitions over a 24-month follow-up period. Results The mean age of the patients was 5.97±2.63 years, with 57.8% of the cases being females. Primary congenital glaucoma represented 44% of the cases. The intraocular pressure decreased from 27.44±4.3 to 12.38±1.46, 14.72±4.11, 16.96±5.57, 15.76±3.75, 15.01±1.33, and 15.07±1.31 mmHg at 1, 3, 6, 12, 18, and 24 months postoperatively, respectively (P≤0.001). Qualified success was achieved in 77.8% of the cases, whereas complete success was reported in 22.2% of the cases. One session of treatment was sufficient in 46.4% of the cases, whereas a second session was needed in 27.8% of the cases, and a third session was needed in 7.8% of the cases. Repetition of treatment was performed at 6 months in 40.6% of the cases. The number of needed sessions and the number of postoperative medications as well as the success rate did not depend on the etiology of refractory pediatric glaucoma. None of the patients lost vision or had more than two lines decrease of best-corrected visual acuity. No major complications were met. However, uveitis occurred in 25.6% of the cases and subconjunctival hemorrhage in 5.6% of the cases; both were completely treated with medical treatment. Antiglaucoma treatment was significantly decreased postoperatively from three to two types of antiglaucoma eyedrops (P≤0.001). Conclusion Micropulse transscleral cyclophotocoagulation with a high energy level is a safe and long-term effective tool to control refractory pediatric glaucoma. Neither the type nor the cause of refractory glaucoma affects the success rate of this procedure.