Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas.
OBJECTIVE
To report the efficacy and complications of diode laser cyclophotocoagulation (cyclodiode) in the management of refractory pediatric glaucomas.


METHODS
Noncomparative interventional case series.


METHODS
Pediatric patients with uncontrolled glaucoma. Seventy-seven eyes of 61 patients underwent cyclodiode. Mean age was 7.4 years (range, 0.4-17 years).


METHODS
Intraocular pressure (IOP), visual acuity, complications.


RESULTS
Diagnoses included aphakic glaucoma, congenital glaucoma, juvenile chronic arthritis, aniridia, anterior segment dysgenesis, and Sturge-Weber syndrome. Sixty percent of eyes were aphakic, and 64% had undergone at least one previous surgical procedure for glaucoma. Patients underwent a mean of 2.3 treatment sessions per eye (maximum, 8 sessions). Mean pretreatment IOP was 32.0 mmHg. After one treatment session, 62% had a clinically useful reduction in IOP (<22 mmHg or by 30%), but this had fallen to 37% by 12 months. With repeat cyclodiode, 72% had a clinically useful reduction in IOP for a year or more (mean, 8.4-month interval between treatments). Aphakic eyes had a more sustained IOP reduction (P < 0.01 log rank test). Of treatment failures, 13% had no useful IOP response, and three eyes developed subsequent retinal detachment and loss of vision. No other eyes lost vision because of cyclodiode-related complications. In 5.5% of the treatment sessions there was a significant posttreatment inflammatory episode. Cyclodiode treatment did not enable a reduction in the number of medications.


CONCLUSIONS
With repeated treatment, cyclodiode can provide effective control of IOP. However, the success rate is lower than with adults, and younger eyes may recover from treatment more rapidly. Although response may be temporary, cyclodiode has a lower rate of severe adverse effects than surgical modalities and has roles as a temporizing measure, as an adjunct to surgery, or in managing selected patients in whom surgery is undesirable because of a high risk of surgical complications.
Kirwan
James F
JF
Paediatric Glaucoma Clinic, Moorfields Eye Hospital. London, England, UK.
Shah
Peter
P
Khaw
Peng T
PT
D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D001036:Aphakia, Postcataract / Q000150:complications; D002648:Child; D002675:Child, Preschool; D002924:Ciliary Body / Q000601:surgery*; D015331:Cohort Studies; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D017075:Laser Coagulation; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome; D014792:Visual Acuity