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    Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas.

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    Authors
    Kirwan, James F.
    Shah, Peter
    Khaw, Peng T.
    Issue Date
    2002
    
    Metadata
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    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
    URI
    http://hdl.handle.net/2436/29497
    DOI
    10.1016/S0161-6420(01)00898-3
    PubMed ID
    11825816
    Additional Links
    https://www.sciencedirect.com/science/article/pii/S0161642001008983?via%3Dihub
    Type
    Journal article
    Language
    en
    ISSN
    0161-6420
    ae974a485f413a2113503eed53cd6c53
    10.1016/S0161-6420(01)00898-3
    Scopus Count
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    Faculty of Education, Health and Wellbeing

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