Cyclophotocoagulation versus sequential tube shunt as a secondary intervention following primary tube shunt failure in pediatric glaucoma

Abstract

Purpose-To examine the efficacy of a sequential tube shunt versus transscleral diode cyclophotocoagulation following failure of an initial tube shunt on maximal medical therapy in treatment of refractory childhood glaucoma.

Failed glaucoma drainage implant: long-term outcomes of a second glaucoma drainage device versus cyclophotocoagulation

“…This suggests that the same aqueous and tissue factors that led to excessive fibrosis and failure of the original implant may, over time, lead to loss of IOP control with the additional implant, despite the increased total surface area available for diffusion over the plates. As with any glaucoma surgery, the tendency for a sequential GDD to fail was more apparent through longer follow-up 14. The number of failures may continue to rise with yet longer follow-up and our study highlights that it is important clinically to follow up these patients for many years following sequential GDD surgery.…”

“…A series of paediatric cases, of which eight eyes underwent implantation with a second tube, were analysed by Sood and Beck . 14 They found a 62.5% success rate with their patients at 26 months of follow-up with a mean IOP of 32.3 mm Hg initially and 19.6 mm Hg at the final follow-up. In the most recent published series by Anand et al ,15 43 eyes were followed up for a mean of 33 months.…”

“…Significant reductions of pressure from 35.7 mm Hg preoperatively to 13.6 mm Hg postoperatively were found but 28.6% were considered to have therapy failure. Another retrospective study, which observed the paediatric population, was conducted by Sood and Beck,14 and of their series of 17 eyes, nine underwent CPC as their second procedure. Reduction of pressure from 31.7 mm Hg preoperatively to 22.5 mm Hg was noted with a mean follow-up time of 19.8 months and a 33% failure rate at 24 months.…”

A Comparison of Sequential Glaucoma Drainage Device Implantation Versus Cyclophotocoagulation Following Failure of a Primary Drainage Device

“…In cases of primary GDD failure, treatment options include revision or replacement of the GDD, placement of a sequential GDD, or cyclodestruction 4 . Diode-laser transscleral cyclophotocoagulation (CPC) is one of the most commonly used procedures to ablate the ciliary body 5 and decrease production of aqueous humor.…”

Childhood glaucoma surgery in the 21st Century

“…116,117 One study comparing cyclophotocoagulation with sequential tube surgery following failure of primary GDD in children suggested similar success and complication rates, although again no long-term follow-up data are available. 118 Our experience with needling and surgical revision suggests that the satisfactory IOP control is short lived especially with needling. After a failed GDD, we usually prefer diode laser as the next procedure before proceeding with a second GDD.…”