Endoscopic Diode Cyclophotocoagulation (ECP) for Refractory Childhood Glaucoma
Tanya S. Glaser; Michael S. Mulvihill; Sharon Freedman
Duke University Eye Center
Introduction: Usually reserved for refractory childhood glaucoma, endoscopic cyclophotocoagulation (ECP) has been used as both primary and adjunctive surgery.[1-3] The purpose was to evaluate ECP as a primary or adjunctive procedure in refractory childhood glaucoma.
Methods: This retrospective study included consecutive ECP for refractory childhood glaucoma from a single surgeon/single site from 12/22/1999-12/22/2016. Successful ECP included postoperative IOP ≤21 mmHg, with or without medications and without severe procedure-related complications or further glaucoma surgery. Cox-proportional hazard modeling and survival analyses were performed.
Results: Included were 113 ECP procedures on 83 eyes/71 children. Glaucoma diagnoses included: following-cataract-surgery (51/61%), anterior segment dysgenesis (10/12%), primary congenital (7/8%), other (15/18%). Mean age at first ECP was 9.2±5.8 years and pre-operative IOP was 27.7±7.8 mmHg. Most eyes (69/83%) had prior glaucoma surgery, 74(84%) eyes were aphakic or pseudophakic at first ECP, 6(7%) phakic, and 3(4%) congenitally aphakic. Mean follow-up was 4.5±3.2 years after initial ECP; mean number of ECP sessions/eye was 1.4 (range 1-3). Kaplan-Meyer success for a single ECP at 1-, 3-, and 5-years was 66%[95% CI 57,78], 37%[27,51] and 20%[(10,38], respectively. Cumulative success (≥1 ECP) at 5-years was 40%[29,55]. Long-term complications were rare and included retinal detachment(1) and chronic inflammation(1). Success was not significantly associated with prior GDD, glaucoma type, or initial IOP.
Discussion: When applied to cases of refractory childhood glaucoma, ECP showed modest success, which declined over time. This large clinical series including diverse refractory childhood glaucoma with long follow up, complements published smaller studies.
Conclusion: ECP represents a relatively safe and modestly effective long-term therapy for refractory childhood glaucoma.
- Al-Haddad CE, Freedman SF. Endoscopic laser cyclophotocoagulation in pediatric glaucoma with corneal opacities. J AAPOS. Feb 2007;11(1):23-28.
2. Carter BC, Plager DA, Neely DE, Sprunger DT, Sondhi N, Roberts GJ. Endoscopic diode laser cyclophotocoagulation in the management of aphakic and pseudophakic glaucoma in children. J AAPOS. Feb 2007;11(1):34-40.
3. Kraus CL, Tychsen L, Lueder GT, Culican SM. Comparison of the effectiveness and safety of transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation in pediatric glaucoma. J Pediatr Ophthalmol Strabismus. Mar-Apr 2014;51(2):120-127.