Cyclodestructive procedures in secondary glaucoma in children

Purpose
Comparison of the effectiveness and safety of cyclocryocoagulation and transscleral contact cyclophotocoagulation with diode laser (TSCPC) in children.

Material and methods
Sixty nine eyes of 60 children at the age from 4 months to 16 years were examinated. Majority of patients was aphakic after congenital, traumatic and complicated cataract extraction. Aniridia, Sturge-Weber disease and ROP complications were observed. In 40 eyes cyclocryotherapy (I group), in 29 eyes TSCPC (II group) were performed. Intraocular pressure (IOP) was assessed in the early and late postoperative period. The number of procedures per one eye, IOP, visual acuity, and complications after cyclodestructive procedures were estimated. Follow-up ranged from 3 months to 4 years, mean 23 months.

Results
Transscleral cyclocryocoagulations were performed once to 4 times in one eye with intervals from 1 month to 1 year, mean 1,3 procedures per eye. TSCPC was performed once in 29 eyes and twice in 4 cases, it was 1,14 procedures per eye. Before treatment IOP ranged from 21,3 to 50,6 mmHg, mean 29,18 mmHg in the I group and 24,4-54 mmHg mean 34,85 mmHg in the II group and in the early postoperative period were 10-25 mmHg, mean 17,7 and 2-26 mmHg, mean 14,65 mmHg relatively. Decreasing of IOP was observed in 39% of eyes after cryotherapy and 57,9% after TSCPC, p = 0,0003. In the longterm follow-up in IOP below 22 mmHg after cyclocryotherapy in 60% of eyes and after TSCPC in 79% was observed. Visual acuity ranged from no light perception to 0,5, mean 0,04. No changes of vision after cyclocryocoagulation were noted. After TSCPC transient visual function decreased from 0,2 to 0,04 in 1 eye but recovered after 2 weeks. After cyclocryotherapy only conjunctival oedema was observed in majority of cases. In the early postoperative period after TSCPC uveitis occured in 3 eyes (10,35%), transient hypotony in 2 eyes, hyphaema in one eye.

Conclusions
Diode cyclophtocoagulation decreases IOP more effective than cyclocryocoagulation in children but complications after TSCPC are more severe than after cyclocryotherapy.