Endocyclophotocoagulation for management of difficult pediatric glaucomas

Introduction: Experience with endoscopic diode laser cyclophotocoagulation remains limited. We report the efficacy and safety profile of this glaucoma surgery technique in the pediatric population. Methods: Retrospective revi ew of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Sur gery was performed by using the Microprobe (Endo Optiks, Little Silver, NJ) integrated laser endoscope system. Patients were followed-up for a minimum of 6 months or until declared treatment failures. Treatment success is def ined as a postoperative intraocular pressure of less than or equal to 21 mm Hg, with or without adjunctive glaucoma medications. Results. Baseline mea n pretreatment intraocular pressure was 35.06 +/- 8.55 mm Hg. Final postope rative intraocular pressure was 23.63 +/- 11.07 mm Hg (30% decrease) after an average of 1.42 +/- 0.87 endolaser procedures and 19.25 +/- 19.36 months of follow-up. Success rate of the initial procedure at last follow-up was 34%. Nine eyes (25%) were retreated at least once. Cumulative success rate after all procedures at last follow-up was 43%. Mean cumulative arc of trea tment was 260 degrees +/- 58 degrees of ciliary processes. Postoperative co mplications included retinal detachment in 2 patients, hypotony in 1 patien t, and progression of vision loss from hand motion to no light perception i n I patient. All 4 complications occurred in aphakic patients. Conclusions: Endoscopic diode laser cyclophotocoagulation is a moderately effective pro cedure for the management of difficult pediatric glaucomas. Aphakic patient s may have an increased risk of significant postoperative complications, su ch as retinal detachment.