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.

Transscleral contact krypton laser cyclophotocoagulation for treatment of posttraumatic glaucoma.

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation in the treatment of posttraumatic glaucoma. PATIENTS AND METHODS: A total of 18 eyes of 18 patients with therapy-resistant posttraumatic glaucoma treated with krypton laser cyclophotocoagulation from 1991 to 1996 were included in this review. The krypton laser was delivered by a fiberoptic probe with simultaneous compression of the sclera. The energy used was 3 to 5 J per application at the tip of the probe, with an exposure time of 10 seconds. The treatment covered 90 to 360 degrees of the ciliary body with approximately 10 applications per quadrant. RESULTS: With one or more cyclophotocoagulation treatments, the intraocular pressure decreased from the baseline mean (+/- standard deviation) of 32.6 +/- 12.8 mm Hg to 23.6 +/- 10.3 mm Hg (n = 17) at 1 month, to 21.8 +/- 7.5 mm Hg (n = 13) at 3 months, to 22.5 +/- 7.6 mm Hg (n = 13) at 6 months, and to 19.6 +/- 10.5 mm Hg (n = 18) at the last control visit (mean, 19.4 months; range, 3 weeks to 73 months) after cyclophotocoagulation but no other glaucoma procedure. At baseline, 17 (94%) of 18 patients were taking glaucoma medication, as were 15 (83%) of 18 patients at the last control visit. One (6%) case of phthisis occurred. CONCLUSIONS: Krypton laser cyclophotocoagulation is an effective and reasonably well tolerated means of lowering intraocular pressure in posttraumatic glaucoma. Because of the refractory nature of the disease, repeated treatments may be needed.