Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma in children and young adults

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation (CPC) in the treatment of glaucoma in young patients. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Transscleral contact krypton laser CPC was performed in 27 glaucomatous eyes of 22 young patients (mean age, 10.5 +/- 5.6 years; range, 11 months-19.4 years). METHODS: The treatment was delivered by means of a fiberoptic probe with compression of the sclera by the probe. The power used was 300 to 500 W per application at the tip of the probe with an exposure time of 10 seconds. MAIN OUTCOME MEASURES: The primary outcome measure is a change in intraocular pressure (IOP). RESULTS: Of the patients who received CPC in both eyes, one eye was randomly chosen for statistical analysis. The mean overall follow-up time was 43.3 +/- 25.3 (median, 36.5; range, 1-82) months after the initial CPC. Preoperatively, the mean intraocular pressure was 35.0 +/- 7.9 mmHg (n = 22). After one or more CPCs, the mean IOP was decreased to 21.5 +/- 8.7 mmHg (n = 22) at 1 month (P < 0.001), to 23.4 +/- 8.6 mmHg (n = 18) at 3 months (P < 0.001), to 25.0 +/- 12.1 mmHg (n = 19) at 6 months (P < 0.01), to 22.1 +/- 9.1 mmHg (n = 16) at 1 year (P < 0.01), and to 22.6 +/- 10.3 (n = 11) at 2 years (P < 0.01). After one or more krypton CPCs, but no other glaucoma procedures, an IOP level of 8 to 21 mmHg or a decrease in IOP of more than 30% was obtained in 14 of 22 (64%) eyes at the last follow-up. No permanent hypotonia, phthisis bulbi, or devastating CPC-related complications were noted. CONCLUSIONS: Krypton laser CPC is a well-tolerated means of lowering IOP in young patients with glaucoma, but repeated treatments may be needed.