Intermediate-term results of endoscopic diode laser cyclophotocoagulation for pediatric glaucoma

Endoscopic diode laser cyclophotocoagulation (EDLC) is a new treatment modality for glaucoma. Experience with this surgical procedure in children is limited. We report our results after 3 years of follow-up and review the safety of this procedure in pediatric patients.

EDLC was performed on 10 eyes of 8 children who had either aphakic glaucoma or refractory congenital glaucoma. Patients were treated in 2 groups. An initial group of 5 eyes with poor visual prognosis underwent a conservative treatment of no more than 180 degrees of ciliary processes. After an observational period, a second group of 5 eyes with better visual potential was treated more aggressively. Most eyes in the second group received cyclophotoablation to 270 degrees of ciliary processes. Patients were followed up until time of failure or for a minimum of 3 years.

At 3 years of follow-up, 50% of eyes that received a single treatment of endolaser had an intraocular pressure (IOP) of < or =22 mm Hg with or without glaucoma medications. Twenty percent had an IOP < or =22 mm Hg without any glaucoma medications. Five eyes were treated successfully with a mean IOP of 17.8 +/- 3.4 mm Hg at 36 months of follow-up. The remaining 5 eyes were considered treatment failures with postoperative IOPs >22 mm Hg, despite adjunctive glaucoma medications. Mean time to treatment failure was 10.5 months (range, 3.7-22.2 months). No sight-threatening complications occurred. None of the eyes became hypotonus or caused undue discomfort during the postoperative period.

EDLC is a relatively safe and effective procedure for the management of difficult pediatric glaucoma. Results are comparable to other cyclodestructive modalities. Although not observed in this study, it should be cautioned that phakic eyes might be at increased risk for surgical complications.