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Long-term outcomes of cyclophotocoagulation in refractory pediatric glaucoma: treatment response and success in 262
Bader Alhazzaa1, Ali Alshahrani2, Sara Aljefri3
1Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; Department of Ophthalmology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
Insights
Cyclophotocoagulation (CPC) for pediatric glaucoma shows varied success rates, often requiring multiple treatments. Older children generally experience better intraocular pressure (IOP) lowering outcomes with CPC therapy.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma Management
- Surgical Interventions
Background:
- Pediatric glaucoma presents unique challenges in intraocular pressure (IOP) management.
- Refractory cases often necessitate advanced treatment modalities.
- Cyclophotocoagulation (CPC) is utilized for severe pediatric glaucoma cases.
Purpose of the Study:
- To evaluate the surgical success and treatment response in children with refractory pediatric glaucoma undergoing cyclophotocoagulation (CPC).
- To assess the long-term efficacy of CPC in managing pediatric glaucoma.
Main Methods:
- Retrospective review of medical records for children undergoing their first CPC procedure between May 2000 and May 2020.
- Assessment of cumulative success probability based on defined intraocular pressure (IOP) thresholds and need for further intervention.
- Analysis of factors influencing treatment success, including patient age.
Main Results:
- Success rates varied significantly based on definition: 26.7% (definition 1) and 46.2% (definition 2).
- Older age at treatment initiation was associated with a reduced risk of failure.
- 41% achieved sustained IOP lowering with a single CPC, while 21% required multiple treatments; 24% showed no response.
Conclusions:
- Cyclophotocoagulation for pediatric glaucoma frequently requires repeat treatments for optimal control.
- Approximately a quarter of pediatric patients exhibit suboptimal responses to CPC.
- Older children demonstrate a higher likelihood of achieving successful IOP reduction with CPC.
Purpose:
To report the surgical success and response to treatment for children undergoing cyclophotocoagulation (CPC) for refractory pediatric glaucoma.
Methods:
The medical records of children with a diagnosis of glaucoma who underwent a first CPC between May 2000 and May 2020 were reviewed retrospectively. The cumulative probability of success was assessed. For definition 1, treatment success was defined as IOP ≤21 mm Hg at all the visits after the first 3 months without the need for additional glaucoma surgery or repeat CPC. For definition 2, repeat CPC did not constitute failure.
Results:
Of 300 eyes that underwent CPC, we identified 262 eyes eligible for inclusion. The mean age at time of first treatment was 5.33 ± 5.03 years, with a mean follow-up of 4.3 ± 4.2 years (31 eyes having at least 10 years of follow-up). The success rates for definitions 1 and 2 were 26.7% (95% CI, 21.7%-32.4%) and 46.2% (95% CI, 40.2%-52.3%), respectively. Older age was associated with a lower risk of failure after both single CPC (HR, 0.92; 95% CI, 0.88-0.96; P < 0.001) and multiple CPCs (HR, 0.95; 95% CI, 0.90-1.00, P = 0.073). Of the 262 eyes, 107 (41%) had sustained IOP-lowering with a single treatment and 56 (21%) with multiple treatments; 35 (13%) had a transient response, and 64 (24%) had no response.
Conclusions:
Glaucoma control through CPC often requires multiple treatments, with around a quarter of children responding suboptimally. Older children are more likely to exhibit successful IOP lowering.
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