Cyclophotocoagulation versus sequential tube shunt as a secondary intervention following primary tube shunt failure in pediatric glaucoma.
OBJECTIVE
To examine the efficacy of a sequential tube shunt versus transscleral diode cyclophotocoagulation following failure of an initial tube shunt on maximal medical therapy in treatment of refractory childhood glaucoma.


METHODS
A nonrandomized retrospective chart review was conducted of 17 eyes of 14 pediatric patients (less than 18 years old) with refractory glaucoma treated with either sequential tube shunt (Group A) or diode cyclophotocoagulation (Group B) following initial failed tube shunt. Success was defined as an intraocular pressure < or =22 mm Hg on medical therapy, no visually devastating complications, and no further glaucoma surgery performed or recommended.


RESULTS
Of the 17 eyes, 8 had a sequential tube shunt and 9 underwent diode cyclophotocoagulation as a secondary procedure. Kaplan-Meier analysis demonstrated a successful outcome of 75% and 62.5% at 12 months and 24 months, respectively, for Group A, and 66.7% at both 12 months and 24 months for Group B (p = 0.48). Corneal decompensation or graft failure was noted in 3/8 eyes (38%) in Group A. Cataract surgery was performed in 2/5 phakic eyes (40%) in Group B. One eye in each group progressed to no light perception.


CONCLUSIONS
Diode cyclophotocoagulation and sequential tube shunt following primary tube shunt failure in childhood glaucoma showed similar efficacy and complication rates. However, the small sample size of this study warrants further evaluation of these 2 procedures following failure of a tube shunt device in pediatric glaucoma.
Sood
Shalini
S
Department of Ophthalmology, Emory University Medical Center, Atlanta, Georgia, USA.
Beck
Allen D
AD
D000293:Adolescent; D000867:Anterior Chamber / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002924:Ciliary Body / Q000601:surgery*; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D017075:Laser Coagulation / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
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