Trans-scleral Diode Laser Cyclophotocoagulation in Children with Refractory Glaucoma. Long-term Outcomes

The aim of this study was to evaluate the efficacy of diode laser cyclophotocoagulation in paediatric patients with refractory glaucoma and to assess complications associated with this method. The study included 69 eyes in 53 children with uncontrolled refractory glaucoma who underwent diode laser cyclophotocoagulation (cyclodiode) treatment. The mean age of this group was 6.1 years (range, 0.9 to 15 years). Intraocular pressure (IOP) and visual acuity were the main parameters evaluated and complications were recorded. The mean follow-up was 4.5 years (range, 1.7 to 8.5 years). The diagnoses included aphakic glaucoma, anterior segment dysgenesis, congenital glaucoma, aniridia, juvenile chronic arthritis and Sturge-Weber syndrome. Fifty-two percent of eyes were aphakic and 78% had undergone at least one previous surgical procedure for glaucoma. The patients underwent a mean of 2.1 treatment sessions per eye (range, 1 to 6). The mean preoperative IOP value was 34.0 mmHg and the mean postoperative value was 20.8 mmHg at the end of the study (P< 0.05). With repeat cyclodiode treatments (mean interval between two successive treatments, 7.1 month), 79% of the eyes had IOP less than 21 mmHg at 1 year and 63 % at 2 years. Four eyes developed subsequent choroidal detachment and two eyes had retinal detachment with a loss of vision. Apart from them, no eyes lost their preoperative vision because of cyclodiode-related complications. It is concluded that cyclophotocoagulation by diode laser is a useful therapy for the treatment of refractory paediatric glaucoma with uncontrolled intraocular pressure. The repeated treatment can provide effective control of IOP with a low risk of severe complications.