Results of micropulse transscleral cyclophotocoagulation in children with secondary glaucoma after congenital cataract surgery: preliminary results

According to the classification of the Childhood Glaucoma Research Network and World Glaucoma Association, pediatric glaucoma is divided into glaucoma associated with congenital eye abnormalities, glaucoma associated with congenital systemic diseases or conditions, glaucoma associated with acquired systemic conditions, and secondary glaucoma after cataract surgery.Secondary childhood glaucoma is a heterogeneous group of diseases resulting from congenital or acquired eye abnormalities, diseases, and systemic syndromes.Secondary glaucoma is among the most common complications after congenital cataract surgery and has an in-cidence of 6 -58%, depending on the anomalies of the eyeball associated with congenital cataract, and the age at which the surgery was performed.The incidence is higher in small eyes and newborns operated on before the age of 4 weeks [1][2][3].According to the Infant Aphakia Treatment Study (IATS), the risk of secondary glaucoma increases to 31% 5 years after cataract removal.Considering this common postoperative complication, it is important to carefully monitor intraocular pressure in children attending followup appointments after congenital cataract surgery.It is also important to remember that children may not manifest discomfort despite a high intraocular pressure.Elevation of intraocular pressure may occur immediately after surgery ABSTRACTIntroduction: This study aimed to evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in children with secondary glaucoma after surgery for congenital cataract. Material and methods:The study group consisted of 22 patients (23 eyes) with secondary glaucoma, who underwent micropulse transscleral cyclophotocoagulation under general anesthesia between 2020 and 2022.The mean age of the patients was 5 years, the youngest child was 11 months old, and the oldest was 17 years old.The eyes were divided into a subgroup in which other anti-glaucoma treatments had previously been used, and a subgroup that received cyclophotocoagulation with a micropulse laser as the first treatment.Pre-and post-MP-TSCPC intraocular pressure was analyzed.Results: The mean pre-MP-TSCPC intraocular pressure in all eyes included in the analysis was 29.56 7.7 mmHg.The mean IOP in the subgroup of eyes with previous anti-glaucoma treatments was 30.75 7.9 mmHg, while the mean IOP in the subgroup without previous treatment was 28.27 7.6 mmHg.After cyclophotocoagulation with the micropulse laser, the mean intraocular pressure in all eyes was 24.44 4.3 mmHg.The mean IOP in the subgroups with and without previous antiglaucoma treatments was 24.1 3.8 mmHg and 24.8 4.9 mmHg, respectively.The mean decrease in IOP was significantly greater in the eyes after previous anti-glaucoma interventions.Conclusions: Micropulse transscleral cyclophotocoagulation appears to be a safe and effective modality for lowering intraocular pressure in children with secondary childhood glaucoma.Its high safety profile and the possibility of repeated performance make MP-TSCPC an effective alternative to other more invasive anti-glaucoma interventions in children.