2.50
Hdl Handle:
http://hdl.handle.net/2436/29497
Title:
Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas.
Authors:
Kirwan, James F.; Shah, Peter; Khaw, Peng T.
Abstract:
PURPOSE: To report the efficacy and complications of diode laser cyclophotocoagulation (cyclodiode) in the management of refractory pediatric glaucomas. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Pediatric patients with uncontrolled glaucoma. Seventy-seven eyes of 61 patients underwent cyclodiode. Mean age was 7.4 years (range, 0.4-17 years). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, complications. RESULTS: Diagnoses included aphakic glaucoma, congenital glaucoma, juvenile chronic arthritis, aniridia, anterior segment dysgenesis, and Sturge-Weber syndrome. Sixty percent of eyes were aphakic, and 64% had undergone at least one previous surgical procedure for glaucoma. Patients underwent a mean of 2.3 treatment sessions per eye (maximum, 8 sessions). Mean pretreatment IOP was 32.0 mmHg. After one treatment session, 62% had a clinically useful reduction in IOP (<22 mmHg or by 30%), but this had fallen to 37% by 12 months. With repeat cyclodiode, 72% had a clinically useful reduction in IOP for a year or more (mean, 8.4-month interval between treatments). Aphakic eyes had a more sustained IOP reduction (P < 0.01 log rank test). Of treatment failures, 13% had no useful IOP response, and three eyes developed subsequent retinal detachment and loss of vision. No other eyes lost vision because of cyclodiode-related complications. In 5.5% of the treatment sessions there was a significant posttreatment inflammatory episode. Cyclodiode treatment did not enable a reduction in the number of medications. CONCLUSIONS: With repeated treatment, cyclodiode can provide effective control of IOP. However, the success rate is lower than with adults, and younger eyes may recover from treatment more rapidly. Although response may be temporary, cyclodiode has a lower rate of severe adverse effects than surgical modalities and has roles as a temporizing measure, as an adjunct to surgery, or in managing selected patients in whom surgery is undesirable because of a high risk of surgical complications.
Citation:
Ophthalmology, 109 (2): 316-323
Publisher:
Elsevier Science Direct
Journal:
Ophthalmology
Issue Date:
2002
URI:
http://hdl.handle.net/2436/29497
DOI:
10.1016/S0161-6420(01)00898-3
PubMed ID:
11825816
Additional Links:
http://www.ingentaconnect.com/content/els/01616420/2002/00000109/00000002/art00898; http://direct.bl.uk/bld/PlaceOrder.do?UIN=107948790&ETOC=RN&from=searchengine
Type:
Article
Language:
en
ISSN:
0161-6420
Appears in Collections:
Centre for Health and Social Care Improvement

Full metadata record

DC FieldValue Language
dc.contributor.authorKirwan, James F.-
dc.contributor.authorShah, Peter-
dc.contributor.authorKhaw, Peng T.-
dc.date.accessioned2008-06-04T11:43:34Z-
dc.date.available2008-06-04T11:43:34Z-
dc.date.issued2002-
dc.identifier.citationOphthalmology, 109 (2): 316-323en
dc.identifier.issn0161-6420-
dc.identifier.pmid11825816-
dc.identifier.doi10.1016/S0161-6420(01)00898-3-
dc.identifier.urihttp://hdl.handle.net/2436/29497-
dc.description.abstractPURPOSE: To report the efficacy and complications of diode laser cyclophotocoagulation (cyclodiode) in the management of refractory pediatric glaucomas. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Pediatric patients with uncontrolled glaucoma. Seventy-seven eyes of 61 patients underwent cyclodiode. Mean age was 7.4 years (range, 0.4-17 years). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, complications. RESULTS: Diagnoses included aphakic glaucoma, congenital glaucoma, juvenile chronic arthritis, aniridia, anterior segment dysgenesis, and Sturge-Weber syndrome. Sixty percent of eyes were aphakic, and 64% had undergone at least one previous surgical procedure for glaucoma. Patients underwent a mean of 2.3 treatment sessions per eye (maximum, 8 sessions). Mean pretreatment IOP was 32.0 mmHg. After one treatment session, 62% had a clinically useful reduction in IOP (<22 mmHg or by 30%), but this had fallen to 37% by 12 months. With repeat cyclodiode, 72% had a clinically useful reduction in IOP for a year or more (mean, 8.4-month interval between treatments). Aphakic eyes had a more sustained IOP reduction (P < 0.01 log rank test). Of treatment failures, 13% had no useful IOP response, and three eyes developed subsequent retinal detachment and loss of vision. No other eyes lost vision because of cyclodiode-related complications. In 5.5% of the treatment sessions there was a significant posttreatment inflammatory episode. Cyclodiode treatment did not enable a reduction in the number of medications. CONCLUSIONS: With repeated treatment, cyclodiode can provide effective control of IOP. However, the success rate is lower than with adults, and younger eyes may recover from treatment more rapidly. Although response may be temporary, cyclodiode has a lower rate of severe adverse effects than surgical modalities and has roles as a temporizing measure, as an adjunct to surgery, or in managing selected patients in whom surgery is undesirable because of a high risk of surgical complications.en
dc.language.isoenen
dc.publisherElsevier Science Directen
dc.relation.urlhttp://www.ingentaconnect.com/content/els/01616420/2002/00000109/00000002/art00898-
dc.relation.urlhttp://direct.bl.uk/bld/PlaceOrder.do?UIN=107948790&ETOC=RN&from=searchengine-
dc.subject.meshAdolescenten
dc.subject.meshAge Distributionen
dc.subject.meshAge Factorsen
dc.subject.meshAphakia, Postcataracten
dc.subject.meshChildrenen
dc.subject.meshChild, Preschoolen
dc.subject.meshCiliary Bodyen
dc.subject.meshCohort Studiesen
dc.subject.meshGlaucomaen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshIntraocular Pressureen
dc.subject.meshLaser Coagulationen
dc.subject.meshPostoperative Complicationsen
dc.subject.meshReoperationen
dc.subject.meshTreatment Outcomeen
dc.subject.meshVisual Acuityen
dc.titleDiode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas.en
dc.typeArticleen
dc.identifier.journalOphthalmologyen

Related articles on PubMed

All Items in WIRE are protected by copyright, with all rights reserved, unless otherwise indicated.