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Abstract #46074 Published in IGR 13-2
Transscleral diode laser cyclophotocoagulation as an initial procedure in congenital glaucoma: Is it a good alternative?
Solarte CE; Morales J; Awad AHJournal of AAPOS 2011; 15: 29-30
Introduction: Certain circumstances prevent to perform angle surgery in congenital glaucoma as primary procedure. Different treatment options must be considered to prevent severe permanent damage, including Transscleral Diode Laser Cyclophotocoagulation (TLDC). The aim of the present study is to revise the efficacy of TLDC and its safety when performed as primary procedure for congenital glaucoma. Methods: Retrospective reviews of patients from 2001 to 2007 that undergo TLDC as primary procedure not eligible for angle surgery. All follow up evaluations were done under sedation or Anesthesia. Successful was defined as IOP less than 22mmHg, improved corneal clarity and/or without changes in corneal diameter with only one session of TLDC using standard parameters. The information was analyzed using Kaplan-Meier Analysis to calculate survival curves. Student's T (Paired - two tailed t-test) was also utilized Results: 26 eyes from 13 boys and 9 girls were included. Age range at presentation was 1-15 Months. Mean follow up was 44 months (9-65). 23 eyes (88%) had IOP less or equal to 22 mmHg and improved corneal clarity at three months follow up. 6 eyes (23%) were under control at one year follow up. Ten eyes required additional sessions of TLDC with good control at one year while the rest undergo different procedures. After 65 months, 20 eyes (77%) showed failure in the overall control of IOP and corneal clarity requiring different procedures. No serious complications were presented in any case Discussion: TDLC has been utilized by some as primary procedure in a variety of adult glaucoma. Previous studies suggested that the pediatric population is less responsive to TDLC. Our results suggested that younger children are even less responsive to TDLC and it works only as a temporary measure although does not present serious complications. Many cases had associated anterior segment anomalies since these eyes are known to do less well even with surgery Conclusions: Primary congenital glaucoma should be treated with surgical intervention directed to the abnormal angle structures. However, some situations prevent to perform conventional procedures. In these situations, TDLC could be a valuable and safe alternative as a temporizing measure until a definitive procedure could be undertaken.
C.E. Solarte.
Classification:
9.1.1 Congenital glaucoma, Buphthalmos (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
12.10 Cyclodestruction (Part of: 12 Surgical treatment)
