Long-term outcomes of cyclophotocoagulation in refractory pediatric glaucoma: treatment response and success in 262 eyes.

PURPOSE: To report the surgical success and response to treatment for children undergoing cyclophotocoagulation (CPC) for refractory pediatric glaucoma.

METHODS

The medical records of children with a diagnosis of glaucoma who underwent a first CPC between May 2000 and May 2020 were reviewed retrospectively. The cumulative probability of success was assessed. For definition 1, treatment success was defined as IOP ≤21 mm Hg at all the visits after the first 3 months without the need for additional glaucoma surgery or repeat CPC. For definition 2, repeat CPC did not constitute failure.

RESULTS

Of 300 eyes that underwent CPC, we identified 262 eyes eligible for inclusion. The mean age at time of first treatment was 5.33 ± 5.03 years, with a mean follow-up of 4.3 ± 4.2 years (31 eyes having at least 10 years of follow-up). The success rates for definitions 1 and 2 were 26.7% (95% CI, 21.7%-32.4%) and 46.2% (95% CI, 40.2%-52.3%), respectively. Older age was associated with a lower risk of failure after both single CPC (HR, 0.92; 95% CI, 0.88-0.96; P < 0.001) and multiple CPCs (HR, 0.95; 95% CI, 0.90-1.00, P = 0.073). Of the 262 eyes, 107 (41%) had sustained IOP-lowering with a single treatment and 56 (21%) with multiple treatments; 35 (13%) had a transient response, and 64 (24%) had no response.

CONCLUSIONS

Glaucoma control through CPC often requires multiple treatments, with around a quarter of children responding suboptimally. Older children are more likely to exhibit successful IOP lowering.