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Transscleral diode laser cyclophotocoagulation for refractory pediatric glaucomas
C J Bock1, S F Freedman, E G Buckley
1Duke University Eye Center, Durham, NC 27710, USA.
Purpose:
To evaluate the success of contact transscleral cyclophotocoagulation (TDC) in patients with refractory pediatric glaucomas.
Methods:
Twenty-six eyes of 20 patients with therapy-resistant pediatric glaucomas were included in this retrospective study. Subgroup analysis was performed for patients 10 or younger and patients older than 10 at time of first TDC procedure. Diode laser cyclophotocoagulation was applied using a fiber optic G-probe. Follow up until time of failure or for a minimum of 6 months was obtained for all procedures in all eyes. Failure was defined as intraocular pressure (IOP) greater than 21 mm Hg, repeat of TDC due to clinically inadequate IOP control, progression to another procedure, or serious complication.
Results:
Baseline mean pretreatment IOP was 34.2 +/- 10.4 mm Hg (range, 15 to 62 mm Hg). Ten of 26 eyes (38%) were successful 6 months after initial TDC. A mean decrease in IOP of 10.3 +/- 14.7 mm Hg was noted after the first procedure (P < 0.05). Eighteen eyes (70%) were retreated at least once. The mean decrease in IOP for all patients after all procedures was 12.9 +/- 13.4 mm Hg (P < 0.001). This represents a mean percent decrease in IOP of 33.2 +/- 6.9%. The overall success rate was 50%, including retreated patients. The younger and older subgroups did not differ with regard to overall success, time to failure, or retreatment rats. One patient suffered a retinal detachment. Visual loss was noted in 4 of 22 eyes with reliable visual acuity measurements.
Conclusion:
TDC is an effective means of decreasing IOP in some patients with refractory pediatric glaucomas. Although the retreatment rate is high, the procedure generally is well tolerated with few complications.
Insights
Contact transscleral cyclophotocoagulation (TDC) effectively lowers intraocular pressure in pediatric glaucoma. While many patients require retreatment, TDC is generally well-tolerated with few complications.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Surgery
Background:
- Pediatric glaucomas are complex conditions requiring effective intraocular pressure (IOP) management.
- Refractory cases present significant challenges to standard treatment protocols.
Purpose of the Study:
- To assess the efficacy and safety of contact transscleral cyclophotocoagulation (TDC) for treating pediatric glaucoma unresponsive to other therapies.
- To evaluate IOP reduction and success rates following TDC in this challenging patient population.
Main Methods:
- Retrospective analysis of 26 eyes from 20 patients with therapy-resistant pediatric glaucomas.
- Diode laser TDC applied using a fiber optic G-probe, with follow-up for at least 6 months or until failure.
- Failure defined by IOP > 21 mm Hg, need for retreatment, further procedures, or serious complications.
Main Results:
- Initial TDC procedures achieved a mean IOP decrease of 10.3 mm Hg (P < 0.05), with 38% success at 6 months.
- Overall success rate, including retreatment, reached 50%, with a mean IOP reduction of 12.9 mm Hg (33.2% decrease) across all procedures (P < 0.001).
- Seventy percent of eyes required at least one retreatment; no significant differences were observed between age subgroups.
Conclusions:
- Contact transscleral cyclophotocoagulation (TDC) demonstrates effectiveness in reducing intraocular pressure for refractory pediatric glaucomas.
- Despite a high retreatment rate, TDC is generally well-tolerated, with a low incidence of serious complications such as retinal detachment.