Endocyclophotocoagulation for management of difficult pediatric glaucomas

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Abstract

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 review of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Surgery 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 defined as a postoperative intraocular pressure of ≤ 21 mm Hg, with or without adjunctive glaucoma medications. Results: Baseline mean pretreatment intraocular pressure was 35.06 ± 8.55 mm Hg. Final postoperative 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 treatment was 260° ± 58° of ciliary processes. Postoperative complications included retinal detachment in 2 patients, hypotony in 1 patient, and progression of vision loss from hand motion to no light perception in 1 patient. All 4 complications occurred in aphakic patients. Conclusions: Endoscopic diode laser cyclophotocoagulation is a moderately effective procedure for the management of difficult pediatric glaucomas. Aphakic patients may have an increased risk of significant postoperative complications, such as retinal detachment.

Original languageEnglish
Pages (from-to)221-229
Number of pages9
JournalJournal of AAPOS
Volume5
Issue number4
DOIs
StatePublished - Aug 2001

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Glaucoma
Pediatrics
Semiconductor Lasers
Intraocular Pressure
Retinal Detachment
Endoscopes
Treatment Failure
Silver
Lasers
Hand
Safety
Light
Therapeutics
Population

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Endocyclophotocoagulation for management of difficult pediatric glaucomas. / Neely, Daniel; Plager, David.

In: Journal of AAPOS, Vol. 5, No. 4, 08.2001, p. 221-229.

Research output: Contribution to journalArticle

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abstract = "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 review of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Surgery 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 defined as a postoperative intraocular pressure of ≤ 21 mm Hg, with or without adjunctive glaucoma medications. Results: Baseline mean pretreatment intraocular pressure was 35.06 ± 8.55 mm Hg. Final postoperative 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 treatment was 260° ± 58° of ciliary processes. Postoperative complications included retinal detachment in 2 patients, hypotony in 1 patient, and progression of vision loss from hand motion to no light perception in 1 patient. All 4 complications occurred in aphakic patients. Conclusions: Endoscopic diode laser cyclophotocoagulation is a moderately effective procedure for the management of difficult pediatric glaucomas. Aphakic patients may have an increased risk of significant postoperative complications, such as retinal detachment.",
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