Purpose: To evaluate the intermediate-term efficacy and safety of micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma. Patients and Methods: A prospective interventional study included children <16 years old diagnosed with recurrent glaucoma, attending Mansoura University, during the period from July 2017 to November 2017. Micropulsed diode laser sessions were performed in all the cases. The main outcome was the intraocular pressure reduction with monitoring of complications as secondary outcome. The mean follow-up period was 15.08 ± 1.1 (mean: 12–16) months. Results: A total of 36 eyes of 29 patients were included (62% males) with median age of 24 months. Primary congenital glaucoma represented 47.2% of the initial diagnoses. At the 15th month, the mean intraocular pressure dropped significantly from 37.5 ± 11.3 mmHg at baseline to 20.03 ± 2.7 mmHg (p < 0.001) with 37.15% reduction. The mean number of glaucoma medications decreased significantly from 2.6 ± 0.5 pretreatment to 1.7 ± 0.6 at the 15th month (p < 0.001). A total of 24 eyes (66.7%) required second session of treatment with mean number of 1.7 ± 0.5 sessions per eye. The cumulative probability of qualified success was 69.4%, 58.3%, 52.8%, 47.2%, and 41.7% at 1, 3, 6, 12, and 15 months after treatment. Qualified success was achieved in 61% at 15 months without statistically significant difference between the initial diagnoses (p = 0.61). None of the eyes developed any major ocular complications throughout the follow-up period. Conclusion: Micropulsed diode laser was proved to be a safe approach with relative effectiveness in controlling intraocular pressure in children with recurrent glaucoma.

PCG is the most prevalent type of childhood glaucoma, followed by acquired glaucoma especially traumatic hyphema. Combined trabeculotomy-trabeculectomy and Ahmed valve implantation are the most common surgical interventions. CGRN classification is found to provide a consensus skeleton and is recommended to be integrated in our routine ongoing clinical practice.

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Prophylactic preoperative and postoperative NSAIDs may have a role in reducing the frequency and severity of CME in diabetic eyes following cataract surgery.

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.