Transscleral diode laser cyclophotocoagulation for refractory pediatric glaucomas

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.