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Lekha Ravindraraj, Sumana Kommana, Robert Fechtner, Albert Khouri; Diode Cyclophotocoagulation for the Treatment of Refractory Childhood Glaucomas. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1852.
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To study the efficacy of diode cyclophotocoagulation (CPC) in the treatment of refractory childhood glaucomas.
A review of records of children with primary congenital glaucoma (PCG) or secondary glaucomas who presented over a 15 year period was conducted. Inclusion: Confirmed diagnosis of childhood glaucomas refractory to other treatments that required CPC for IOP control. Exclusion: Lack of follow-up (<6 months), treatment not inclusive of CPC. Data on intraocular pressure (IOP), number of glaucoma medications at baseline, 1year and 2 years after CPC, and laser settings [number/degree of treatment applications, time, & power (mW)] were collected. Means, SD, T-tests, and percent reductions in IOP were calculated.
Of 61 patients (yielding 101 eyes) with childhood glaucomas, a total of 14 patients (7 with PCG and 7 with secondary causes of glaucoma) with 17 eyes (8 PCG and 9 secondary) received 35 CPC’s (15 for PCG & 20 for secondary glaucomas). Extent of treatment was: 59% in 3 quadrants, 25% in 4 quadrants, & 16% in 2 quadrants. Mean laser parameters were: count of 22.4 (SD 4.5), power at 1393 mW (SD 346.7), time of 3154 seconds (SD 980.9). Six of the 17 eyes had a previous glaucoma procedure before being treated by CPC. Fifty-three percent (9 of 17 eyes) received CPC only once, while 47% required >1 treatment (with 2, 4, and 2 eyes receiving 2, 3, and >3 CPC’s, respectively). There was a significant reduction in IOP (mmHg) from 39.2 at baseline (n=33), to 25.4 (n=22, p<0.001) at 1 year and 29.2 (n=14, p<0.01) at 2 years of follow-up. There was no significant reduction in the number of glaucoma medications (p>0.05) (1.9 at baseline to 2.1 at 1 year and 2.0 at 2 years). Percent IOP reductions at 1 and 2 years are included in Table 1.
CPC significantly reduced IOP in refractory childhood glaucomas. The majority of eyes achieved IOP reductions >20% at 1 and 2 years, however the effect was more robust at 1 year vs 2 years. Multiple CPCs were required in 47% of eyes. Long term follow-up is needed to better characterize CPC efficacy and its potential as an adjunct in the treatment of refractory childhood glaucomas.
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