Micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma.

PURPOSE: To evaluate the intermediate-term efficacy and safety of micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma. PATIENTS AND METHODS: A prospective interventional study included children <16 years old diagnosed with recurrent glaucoma, attending Mansoura University, during the period from July 2017 to November 2017. Micropulsed diode laser sessions were performed in all the cases. The main outcome was the intraocular pressure reduction with monitoring of complications as secondary outcome. The mean follow-up period was 15.08 ± 1.1 (mean: 12-16) months. RESULTS: A total of 36 eyes of 29 patients were included (62% males) with median age of 24 months. Primary congenital glaucoma represented 47.2% of the initial diagnoses. At the 15th month, the mean intraocular pressure dropped significantly from 37.5 ± 11.3 mmHg at baseline to 20.03 ± 2.7 mmHg (p < 0.001) with 37.15% reduction. The mean number of glaucoma medications decreased significantly from 2.6 ± 0.5 pretreatment to 1.7 ± 0.6 at the 15th month (p < 0.001). A total of 24 eyes (66.7%) required second session of treatment with mean number of 1.7 ± 0.5 sessions per eye. The cumulative probability of qualified success was 69.4%, 58.3%, 52.8%, 47.2%, and 41.7% at 1, 3, 6, 12, and 15 months after treatment. Qualified success was achieved in 61% at 15 months without statistically significant difference between the initial diagnoses (p = 0.61). None of the eyes developed any major ocular complications throughout the follow-up period. CONCLUSION: Micropulsed diode laser was proved to be a safe approach with relative effectiveness in controlling intraocular pressure in children with recurrent glaucoma.

Trimanual Versus Unimanual 23-Gauge Vitrectomy in Patients With Diabetes: Limitations and Expectations.

BACKGROUND AND OBJECTIVE: To compare between trimanual and unimanual vitrectomy in complicated proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: A prospective, non-randomized, comparative study including patients with tractional retinal detachment (TRD), vitreous hemorrhage with TRD, and combined TRD with rhegmatogenous retinal detachment. The patients were allocated into two groups: the unimanual group with three-port vitrectomy and the trimanual group with added fourth sclerotomy, through which the endoillumination probe was guided by the assistant. The primary outcomes included the intraoperative feasibility, operative time, and complications. RESULTS: Eighty-two eyes were categorized into the two groups: 44 eyes in the unimanual group and 38 eyes in the trimanual group. Operative time was significantly shorter in the trimanual group (P < .005). The incidence of iatrogenic breaks and intraoperative bleeding was significantly higher in the unimanual group (P = .034 and P = .044, respectively). Primary anatomic success was achieved in 90.9% and 94.7% in unimanual and trimanual groups, respectively, without significant difference (P = .411). There was no significant difference in the postoperative complications. CONCLUSIONS: Trimanual vitrectomy was proven to be a safe and effective technique in managing complicated PDR. It results in anatomical outcomes comparable to standard unimanual vitrectomy with fewer intraoperative complications. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:42-49.].