[Cyclodestructive procedures in secondary glaucoma in children]

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology

Background:

• Pediatric glaucoma management often requires interventions to control intraocular pressure (IOP).
• Cyclodestructive procedures are utilized when other treatments fail.
• Comparison of cyclocryocoagulation and transscleral contact cyclophotocoagulation (TSCPC) in pediatric populations is crucial for treatment selection.

Purpose of the Study:

• To compare the effectiveness and safety of cyclocryocoagulation versus diode laser transscleral contact cyclophotocoagulation (TSCPC) in pediatric patients.
• To evaluate intraocular pressure (IOP) reduction and complication rates for both procedures.

Main Methods:

• Sixty-nine eyes of 60 children (4 months to 16 years) underwent either cyclocryotherapy (40 eyes) or TSCPC (29 eyes).
• Patients included those aphakic post-cataract extraction, with aniridia, Sturge-Weber disease, or ROP complications.
• Intraocular pressure (IOP), visual acuity, and complications were assessed in early and late postoperative periods with a mean follow-up of 23 months.

Main Results:

• TSCPC required fewer procedures per eye (1.14) compared to cyclocryotherapy (1.3).
• IOP reduction was significantly greater with TSCPC (57.9% of eyes) than cyclocryotherapy (39% of eyes) (p=0.0003).
• Long-term IOP below 22 mmHg was achieved in 79% of eyes after TSCPC versus 60% after cyclocryotherapy; however, TSCPC had more severe complications including uveitis and transient hypotony.

Conclusions:

• Diode laser TSCPC demonstrates superior efficacy in lowering IOP in children compared to cyclocryocoagulation.
• While effective, TSCPC is associated with a higher incidence of more severe complications than cyclocryotherapy.
• Treatment choice requires careful consideration of efficacy versus potential adverse events in pediatric glaucoma management.