Cyclodiode Laser as the First Surgical Approach in Childhood Glaucoma Under the Age of 8 Years. Issue 4 (April 2021)

• Record Type: Journal Article
• Authors: Sakaorat, Petchyim; Mohamed-Noriega, Jibran; Sharara, Ahmad; Daniel, Moritz C.; Brookes, John
• Is Part Of: Journal of glaucoma. Volume 30:Issue 4(2021)
• Publication Date: 2021-04
• Subjects: childhood glaucoma -- pediatric glaucoma -- cyclodiode -- cyclophotocoagulation -- cyclodestructive procedures -- primary treatment; Glaucoma -- Periodicals; 617.741005
• DOI: 10.1097/IJG.0000000000001754
• Languages: English
• ISSNs: 1057-0829

Abstract

Abstract : Précis: Cyclodiode as a primary treatment for childhood glaucoma patients younger than 8 years has a 12-month success rate of 55.24%. It can delay the need for penetrating glaucoma surgery. Purpose: The purpose of this study was to evaluate the treatment outcome of cyclodiode laser in childhood glaucoma for patients under the age of 8 years. Design: This was a retrospective, consecutive, noncomparative case series Participants: All childhood glaucoma patients who underwent cyclodiode from March 2005 to January 2017 as a primary surgical treatment under the age of 8 years. Methods: A retrospective review of the medical records of consecutive patients who underwent cyclodiode by a single surgeon. Main Outcome Measures: Success for single-diode intervention was defined as intraocular pressure (IOP) (>6 wk postoperative) ⩽21 mm Hg with antiglaucoma medications and ≥20% IOP reduction, no further glaucoma surgery including cyclodiode, no loss of perception of light, and no major complications. Success for multiple-diode interventions was defined similar to the single diode, except that repeated cyclodiode is not considered a failure. Results: In all, 59 eyes of 43 patients were studied. The most common diagnosis was aphakic glaucoma. The mean age at cyclodiode treatment was 2.7 years (SD=2.2). Fifty-six percent of the patients were under 3 years. Success rates at 12 months after the procedure were 46.67% and 55.24% for single-diode and multiple-diode interventions, respectively. An IOP of >20 mm Hg 6 weeks after a cyclodiode session is a significant risk factor for failure with an hazard ratio of 2.41 (95% confidence interval: 1.00-5.81; P =0.05). Among the operated eyes, the surgeon could avoid further glaucoma surgery in 67.8% of the eyes during the first year after single or multiple cyclodiode sessions. None of the eyes experienced phthisis bulbi, hypotony, and severe uveitis. Conclusions: Cyclodiode laser in childhood glaucoma patients under the age of 8 years can be considered a safe alternative for glaucoma patients who can have a high risk of surgical complications. Performing cyclodiode laser can delay the need for penetrating glaucoma surgery. The IOP at 6 weeks may be a good predictor for the treatment outcome.