Abstract
Purpose :
The management of pediatric glaucoma is an ongoing and challenging problem where multiple modalities such medication and surgery are employed to achieve intraocular pressure control. While cyclodestructive procedures have been relegated to poor prognosis eyes, we propose it as an adjective procedure when a second shunt is considered due to inadequate control or clinically problematic medicamentosa is an issue. In this study, we retrospectively review outcomes of patients who underwent micropulse transscleral cyclophotocoagulation (MP-CPC) and analyze the impact on intraocular pressure (IOP), number of medications, complications, and need for further surgery.
Methods :
We analyzed longitudinal data from patients aged 0-18 years with diagnosis of glaucoma who underwent MP-CPC at a Childrens Hospital Los Angeles between 1/1/2018-9/30/2023. Complete surgical success was defined as an IOP of 5 to 21mmHg at the last follow-up visit, with no other signs of glaucoma progression. Qualified success was defined as an IOP ≤21mmHg on medications in addition to at least 20% reduction in IOP and/or a reduction in the number of medications used.
Results :
One hundred and eighteen eyes of 77 patients (mean age, 11.1 ± 4.4 years; 38 female, 39 male) were included in the study. The mean IOP and mean number of antiglaucoma medications at pre-procedure were 26.8 ± 8.3 mmHg and 3.8 ± 1.1, respectively. The average follow-up time was 25.1 ± 17.9 months. Complete success was achieved in 12.8% (15) of eyes and qualified success was achieved in 64.9% (61) at their most recent follow-up visit. The mean number of glaucoma medications at the most recent follow-up visit was 2.5 ± 1.5 (p<0.001) with an average IOP of 17.6 ± 5.3 mmHg. Eight eyes required additional glaucoma surgery following MP-TSCPC, and 4 eyes developed complications, specifically, rhegmatogenous retinal detachments.
Conclusions :
Micropulse transscleral cyclophotocoagulation as a treatment for refractory pediatric glaucoma is an effective option for lowering IOP and number of glaucoma medications in our patient population.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.