P. Hamard et al., Contact transscleral diode laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma, J FR OPHTAL, 23(8), 2000, pp. 773-780
Purpose: To evaluate the success rate of contact diode transscleral cycloph
otocoagulation (TSCPC) in pediatric refractory glaucoma.
Patients and method: Twenty-eight eyes of 28 patients (age range 5 months t
o 26 years) with medical and surgical refractory pediatric glaucoma due to
primary congenital glaucoma (group 1, 20 eyes) or aphakic congenital glauco
ma (group 2. 8 eyes), were included in this retrospective study. All eyes u
nderwent one or more TSCPC with the diode laser (Oculight SLX, Iris Medical
) with a minimal follow-up of 2 months. Success was defined as intraocular
pressure (IOP) between 6 and 20 mmHg after one or more procedures, with no
increase in medical hypotensive therapy, and no progression to another hypo
tensive procedure.
Results: Mean baseline IOP was 29.4 +/- 7.8 mmHg (range 25 to 60 mmHg) and
mean followup was 10.3 +/- 6.9 months (range 2 to 26 months). Success rates
evaluated at 6 and 12 months (Kaplan Meier survival curves) were 54.4% and
27.7% respectively, with one-third of the eyes retreated once or more. The
se success rates were similar in both groups with a mean baseline IOP decre
ase of 38.9 +/- 15.9%. Postoperative uncontrolled hypertony occurred in the
first 3 months in 6 (21.4%) eyes, leading to surgical IOP management. Othe
r complications were decrease in visual acuity (14.3%), inflammation (25.5%
) and phthisis (3.5%)
Conclusion: TSCPC with the diode laser is a disappointing procedure for the
management of refractory pediatric glaucoma, with poor mid-term IOP contro
l and high incidence of complications including severe uncontrolled IOP inc
rease. For these reasons, this cyclodestructive procedure should be conside
red as a last resort therapy for patients with refractory pediatric glaucom
a.