Micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma

Abstract

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.

An update on continuous‐wave cyclophotocoagulation (CW‐CPC) and micropulse transscleral laser treatment (MP‐TLT) for adult and paediatric refractory glaucoma

“…Although the case series was too small to show statistical significance, the change in choroidal thickness could be due to an increased uveoscleral outflow after MP‐TLT. Moreover, among the studies that have reported the IOP outcomes 1 or 8 days after surgery, a maximum IOP lowering was often observed from the first week and then the IOP tended to rise, reaching its peak at 1 month (Aquino et al 2015; Abdelrahman & El Sayed 2018; Al Habash et al 2019; Souissi et al 2019; Garcia et al 2020; Magacho et al 2020) or at 3 months (Lee et al 2017; Barac et al 2018; Yelenskiy et al 2018; Elheifney et al 2019; Nguyen et al 2019; de Crom et al 2020; Wong et al 2020). These findings suggest a potential very early effect due to a nonlethal thermal damage to the pars plana of the CB, improving uveoscleral outflow via a therapeutic cellular biochemical cascade.…”

“…This method could have lead to cyclophotocoagulation, as the total laser application duration was greater than 3 s per site, which is longer than the commonly used transscleral cyclophotocoagulation, despite not using a continuous motion and, therefore, the thermal effect was lower than with the traditional technique. Retreatments: the literature on retreatment is limited. The studies with the highest retreatment rates (≥20%) were those in which the delivered energies were modest (<100 J) (Tan et al 2010; Aquino et al 2015; Elheifney et al 2019; Nguyen et al 2019; de Crom et al 2020; Radhakrishnan et al 2020; Tekeli & Köse 2020) and/or the mean preoperative IOP was too high (>30 mmHg) to reach the success endpoint after a single session (Tan et al 2010; Aquino et al 2015; Elheifney et al 2019; Jammal et al 2019; Preda et al 2020; Tekeli & Köse 2020). Tekeli & Köse (2020) have found a significantly higher retreatment rate in eyes with other types of secondary glaucoma than in eyes with POAG and PXG.…”

Primary congenital glaucoma: An updated review

“…Therefore, this modality is usually reserved for cases with poor potential after failure of multiple surgeries. Finally, micropulse trans-scleral diode laser was recently introduced as a viable alternative cyclodestructive procedure that has a higher safety profile with satisfactory efficacy 85, 86, 87. However, its efficacy is often transient and several sessions may be necessary 85, 86, 87…”

A Review of Cyclodestructive Procedures for the Treatment of Glaucoma

“…In a study of 36 pediatric glaucoma eyes, Elhefney et al reported that IOP was reduced from 37.5 mmHg to 20.0 mmHg, and medications reduced from 2.6 to 1.7, 15 months after MP-TLT. 51 Sixty-six percent of eyes required a second treatment session to maintain control of IOP, and no major complications were observed in any patients. 51 Notably, Abdelrahman et al compared CW-TSCPC and MP-TLT in a cohort of pediatric refractory glaucoma patients.…”

“…51 Sixty-six percent of eyes required a second treatment session to maintain control of IOP, and no major complications were observed in any patients. 51 Notably, Abdelrahman et al compared CW-TSCPC and MP-TLT in a cohort of pediatric refractory glaucoma patients. With success defined as an IOP between 5 and 21 mmHg in the absence no vision-threatening complications at 6 months, the authors reported a greater success rate in the MP-TLT (71%) group compared to the CW-TSCPC (46%) group, however, this difference was not statistically significant.…”