Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma in children and young adults

Abstract

Purpose To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation (CPC) in the treatment of glaucoma in young patients. Design Retrospective noncomparative interventional case series. Participants Transscleral contact krypton laser CPC was performed in 27 glaucomatous eyes of 22 young patients (mean age, 10.5 ± 5.6 years; range, 11 months–19.4 years). Methods The treatment was delivered by means of a fiberoptic probe with compression of the sclera by the probe. The power used was 300 to 500 W per application at the tip of the probe with an exposure time of 10 seconds. Main outcome measures The primary outcome measure is a change in intraocular pressure (IOP). Results Of the patients who received CPC in both eyes, one eye was randomly chosen for statistical analysis. The mean overall follow-up time was 43.3 ± 25.3 (median, 36.5; range, 1–82) months after the initial CPC. Preoperatively, the mean intraocular pressure was 35.0 ± 7.9 mmHg (n = 22). After one or more CPCs, the mean IOP was decreased to 21.5 ± 8.7 mmHg (n = 22) at 1 month ( P < 0.001), to 23.4 ± 8.6 mmHg (n = 18) at 3 months ( P < 0.001), to 25.0 ± 12.1 mmHg (n = 19) at 6 months ( P < 0.01), to 22.1 ± 9.1 mmHg (n = 16) at 1 year ( P < 0.01), and to 22.6 ± 10.3 (n = 11) at 2 years ( P < 0.01). After one or more krypton CPCs, but no other glaucoma procedures, an IOP level of 8 to 21 mmHg or a decrease in IOP of more than 30% was obtained in 14 of 22 (64%) eyes at the last follow-up. No permanent hypotonia, phthisis bulbi, or devastating CPC-related complications were noted. Conclusions Krypton laser CPC is a well-tolerated means of lowering IOP in young patients with glaucoma, but repeated treatments may be needed.