Abstract
Purpose :
To compare the use of the Micropulse (MP) cyclophotocoagulation (CPC) to the standard of care Continuous Wave (CW) CPC in the treatment of refractory pediatric glaucoma.
Methods :
The data was collected at University Hospital in Newark, NJ, from 2011 to 2019. This retrospective analysis included patients that received MP or CW below 18 years of age with primary or secondary glaucoma. Patients have failed conventional glaucoma surgery or presented with end-stage disease and poor visual prognosis. Patients with poor follow-up at 1, 3, 6 and 12 months, or that required enucleation, were excluded from the analysis. The data collected includes demographics, intraocular pressure (IOP), number of glaucoma medications, and laser settings including duration, energy and number of shots. Table 1 summarizes treatment parameters. The paired t-test was used to compare IOP and number of medications, and the rate of retreatment was calculated per procedure type, summarized in Table 2.
Results :
In 22 patients, 31 eyes qualified for this analysis. 13 eyes were treated with MP and 18 eyes with CW. There were 23 MP treatments and 38 CW, for 61 total treatments. The mean baseline IOP in the MP cohort was 31.6 and in CW was 38.9. At 3 months follow-up, the MP mean IOP was 28.8 and CW was 26.5. At 6 months, MP mean IOP was 31.2 and CW was 30.8. At 1 year, MP mean IOP was 34.0 and CW was 26.5. IOP comparison in the CW group revealed a significant decrease at 3 months (p=0.02) and 1 year (p<0.001). The mean number of glaucoma medications in patients increased from 1.7 to 2 after MP and from 1.56 to 1.61 after CW at 1 year. The percentage of eyes that required retreatment 6 months after treatment with MP was 46% and after CW was 28%.
Conclusions :
In this cohort, CW had a more significant decrease in IOP over 1 year. After 6 months, both groups experienced elevations in IOP, often requiring repeat treatments. As expected, the retreatment rate in our cohort was higher in MP. The laser parameters employed may not have been optimal for this cohort with refractory pediatric glaucoma. Further studies are needed to elucidate the parameters that would optimize the efficacy and safety of MP and CW in children with refractory glaucoma of different etiologies, to determine the most preferable approach.
This is a 2020 ARVO Annual Meeting abstract.