Laser Treatment of Glaucoma in Children

Purpose: tо analyze the possibility and effectiveness of laser surgery for glaucoma in children.

Materials and methods. An analysis of 679 different types of laser surgeries for glaucoma in children was performed: iridotomy, iridectomy, goniosynechotomy, anterior and posterior synchotomy, destruction of pupillary membranes, anterior hyaloidotomy, continuous-wave and micropulse diode laser transscleral cyclophotocoagulation. Laser surgeries were performed in the Department of Pediatric Eye Pathology of the Helmholtz National Medical Research Center of Eye Diseases. The age of children ranged from 2 months to 17 years (including 1/3 of children under 3 years of age).

Results. The main indications for YAG laser reconstructive surgery are: pupillary block, internal fistula block after trabeculectomy, goniosynechia, iridocorneal adhesions, pupillary membranes. The most popular and effective YAG laser interventions for childhood glaucoma are determined: iridectomy, refistulization after trabeculectomy (synechectomy, correction of internal fistula and iris coloboma), destruction of pupillary membranes.

Conclusion. Clinical polymorphism of glaucomas in children determines the diversity of types of blockade of the outflow tract of the intraocular fluid, some of which can be eliminated by laser. YAG laser surgery is an effective non-invasive low-traumatic means of correcting complications of hypotensive operations (usually trabeculectomy), cataract removal, uveitis and their consequences. Laser glaucoma operations are a worthy alternative to repeated instrumental glaucoma surgery with opening of the eyeball. Our experience allows us to recommend widespread implementation of these operations into clinical practice.

1. Thau A, Lloyd M, Freedman S. New classification system for pediatric glaucoma: implications for clinical care and a research registry. Curr Opin Ophthalmol. 2018;29:385–394. doi: 10.1097/ICU.0000000000000516.

2. Papadopoulos M, Vanner EA, Grajewski AL. International Study of Childhood Glaucoma. Ophthalmology Glaucoma. 2020;3(2):145-157. doi: 10.1016/j.ogla.2019.12.007.

3. Sadovnikova NN, Brzheskij VV, Zercalova MA. The structure of “childhood” glaucoma — results of 20-year observation. National Journal of Glaucoma. 2023;22(2):71–80 (In Russ.). doi: 10.53432/2078-4104-2023-22-2-71-80.

4. Weinreb RN, Grajewski AL, Papadopoulos M, Grigg J, Freedman SF. Childhood glaucoma: the 9th consensus report of the World Glaucoma Association. Netherlands: Kugler Publications, 2013.

5. Yu-Wai-Man C, Arno G, Brookes J. Primary congenital glaucoma including next generation sequencing-based approaches: clinical utility gene card. Eur J Hum Genet. 2018;26:1713–1718. doi: 10.1038/s41431-018-0227-y.

6. Lewis CJ, Hedberg-Buenz A, DeLuca AP, Stone EM, Alward WLM, Fingert JH. Primary congenital and developmental glaucomas. Hum Mol Genet. 2017;26(R1):28–36. doi: 10.1093/hmg/ddx205.

7. Barke M, Dhoot R, Feldman R. Pediatric Glaucoma: Diagnosis, management, treatment. International Ophthalmology Clinics. 2022;62(1):95–109. doi: 10.1097/IIO.0000000000000401.

8. Fung DS, Roensch MA, Kooner KS. Epidemiology and characteristics of childhood glaucoma: results from the Dallas Glaucoma Registry. Clin Ophthalmol. 2013;7:1739–1746. doi: 10.2147/OPTH.S45480.

9. Hvatova AV. Congenital glaucoma: a modern view of pathogenesis and treatment. Visual functions and their correction in children. Moscow: Medicina; 2005:319– 344 (In Russ.).

10. Sidorov EG., Mirzajanc MG. Congenital glaucoma and its treatment. Moscow: Medicina; 1991:208 (In Russ.).

11. Katargina LA, Mazanova EV, Tarasenkov AO. Federal clinical guidelines. Diagnostics, drug and surgical treatment of children with congenital glaucoma. Russian Pediatric Ophthalmology. 2016;11(1):33–51 (In Russ.).

12. Sng CC, Barton K. Mechanism and management of angle closure in uveitis. Curr Opin Ophthalmol. 2015;26(2):121–127. doi: 10.1097/ICU.0000000000000136.

13. Muñoz-Negrete FJ, Moreno-Montañés J, Hernández-Martínez P. Current approach in the diagnosis and management of uveitic glaucoma. Biomed Res Int. 2015;5:1–13. doi: 10.1155/2015/742792.

14. Kalogeropoulos D, Sung VC. Pathogenesis of uveitic glaucoma. J Curr Glaucoma Pract. 2018;12(3):125–138. doi: 10.5005/jp-journals-10028-1257.

15. Katargina LA, Khvatova AV. Endogenous uveitis in children and adolescents. Moscow: Meditsina; 2000:320 (In Russ.).

16. Vajpayee RB, Angra SK, Titiyal JS, Sharma YR, Chabbra VK. Pseudophakic pupillary-block glaucoma in children. Am J Ophthalmol. 1991 Jun 15;111(6):715–718. doi: 10.1016/s0002-9394(14)76777-7.

17. Saprykin PI, Kalent’ev AYu. Laser microsurgery of organic pupillary block. Journal of Ophthalmology (Ukraine). 1983;3:160–162 (In Russ.).

18. Hvatova AV. Diseases of the lens in children. Leningrad: Medicine, 1982:200 (In Russ.).

19. Stepanov AV. Modern methods of pathogenetically oriented microsurgery of post-traumatic glaucoma. Journal of Ophthalmology (Ukraine). 1987;4:193–198 (In Russ.).

20. Neroev VV, Arestova NN. Laser reconstructive surgery for eye diseases in children. Moscow: RAN Publ.; 2018:304 (In Russ.).

21. Arestova NN, Arestov DO, Panova AYu. Influence of various factors on the effectiveness of trabeculectomy in children with congenital glaucoma. Russian Pediatric Ophthalmology. 2024;19(2):59–71 (In Russ.). doi: 10.17816/rpoj629264.

22. Sorokin EL, Mamedov NG, Egorov VV. Causes of increased intraocular pressure after glaucoma surgery and the possibility of eliminating them using laser methods. Ophthalmosurgery. 1995;1:24–30 (In Russ.).

23. De Alwis TV. The long-term follow-up of patients treated with YAG laser to re-open closed or closing fistulae following glaucoma surgery. Eye. 1993;7(3):444–445. doi: 10.1038/eye.1993.89.

24. Ruzickova E, Pitrova S, Rihova E. Laserova mikrochirurgie u neefektivnich antiglaukomatoznich operaci [Laser microsurgery after ineffective anti-glaucoma surgery]. Cesk-Oftalmol. 1989;45(2):95–99 (In Czech).

25. Katargina LA, Arestova NN, Denisova EV, Ibejd BNA. YAG laser refistulization of internal fistula after sinus trabeculectomy in children with uveal glaucoma. Oftal’mohirurgija. 2019;1:57–61 (In Russ.). doi: 10.25276/0235-4160-2019-1-57-6.

26. Janssens R, van Rijn LJ, Eggink CA, Jansonius NM, Janssen SF. Ultrasound biomicroscopy of the anterior segment in patients with primary congenital glaucoma: a review of the literature. Acta Ophthalmol. 2022 Sep;100(6):605–613. doi: 10.1111/aos.15082.

27. Abdeen W, Esmael AF, Gawdat G, El-Fayoumi D. Anterior chamber angle features in primary congenital glaucoma infants using hand-held anterior segment-oct. Eye (Lond). 2022 Jun;36(6):1238–1245. doi: 10.1038/s41433-021-01583-1.

28. Tan Y-L, Chua J, Ho C.-L. Updates on the surgical management of pediatric glaucoma. Asia-Pacific J Ophthalmol. 2016;5:85–92. doi: 10.1097/APO.0000000000000182.

29. Chen TC, Chen Philip P, Francis BA. Pediatric glaucoma surgery a report by the American Academy of Ophthalmology. Ophthalmology. 2014;121:2107–2115. doi: 10.1016/j.ophtha.2014.05.010.

30. Kulkarni SV, Damji KF, Fournier AV, Pan I, Hodge WG. Endoscopic goniotomy: early clinical experience in congenital glaucoma. J Glaucoma. 2010;19:264–269. doi: 10.1097/IJG.0b013e3181b21ede.

31. Bayraktar S, Koseoglu T. Endoscopic goniotomy with anterior chamber maintainer: Surgical technique and one year results. Ophthalmic Surg Lasers. 2001;32:496–502. doi: 10.3928/1542-8877-20011101-15.

32. Girkin CA, Rhodes L, McGwin G. Goniotomy versus circumferential trabeculotomy with an illuminated microcatheter in congenital glaucoma. J AAPOS. 2012;16:424–427. doi: 10.1016/j.jaapos.2012.05.013.

33. Dao JB, Sarkisian SR Jr., Freedman SF. Illuminated microcatheter-facilitated360degree trabeculotomy for refractory aphakic and juvenile open-angle glaucoma. Journal of Glaucoma. 2014;23(7):449–454. doi: 10.1097/IJG.0b013e31829484df.

34. Lee YJ, Ha A, Kang D. Comparative efficacies of 13 surgical interventions for primary congenital glaucoma in children: a network meta-analysis of randomized clinical trials. Int J Surg. 2023 Apr 1;109(4):953–962. doi: 10.1097/JS9.0000000000000283.

35. Lim ME, Neely DE, Wang J. Comparison of 360-degree versus traditional trabeculotomy in pediatric glaucoma. J AAPOS. 2015;19:145–149. doi: 10.1016/j.jaapos.2015.01.008.

36. Scuderi GL, Pasquale N. Laser therapies for glaucoma: new frontiers. Progressin Brain Research. 2008;173:225–236. doi: 10.1016/S0079-6123(08)01116-3.

37. Yumita A, Shirato S, Yamamoto T. Goniotomy with Q-switched NdYAG laser in juvenile developmental glaucoma: a preliminary report. Jpn. J. Ophthalmol. 1984;28(4):349–355.

38. Yeung HH, Walton DS. Goniotomy for juvenile open-angle glaucoma. J Glaucoma. 2010;19:1–4. doi: 10.1097/IJG.0b013e3181a2fa31.

39. Baris M, Biler ED, Yilmaz SG. Treatment results in aphakic patients with glaucoma following congenital cataract surgery. Int Ophthalmol. 2019;39:11–19. doi: 10.1007/s10792-017-0777-y.

40. Chen TC, Walton DS. Goniosurgery for prevention of aniridic glaucoma. Arch Ophthalmol. 1999;117:1144–1148. doi: 10.1001/archopht.117.9.1144.

41. Beck AD, Wilson WR, Lynch MG. Trabeculectomy with adjunctive mitomycin c in pediatric glaucoma. Am J Ophthalmol. 1998;126:648–657. doi: 10.1016/S00029394(98)00227-X.

42. Khan AO. A Surgical Approach to Pediatric Glaucoma. The Open Ophthalmology Journal/ 2015;9:104–112. doi: 10.2174/1874364101509010104.

43. Scuderi G, Iacovello D, Pranno F, Plateroti P, Scuderi L. Pediatric Glaucoma: A Literature’s Review and Analysis of Surgical Results. Hindawi Publishing Corporation. BioMed Research International. 2015;Article ID 393670:8. doi: 10.1155/2015/393670.

44. Sidoti PA, Belmonte SJ, Liebmann JM, Ritch R. Trabeculectomy with mitomycinC in the treatment of pediatric glaucomas. Ophthalmology. 2000;104:422–429. doi: 10.1016/S0161-6420(99)00130-X.

45. Giampani J Jr, Borges-Giampani AS, Carani JC, Oltrogge EW, Susanna R Jr. Efficacy and safety of trabeculectomy with mitomycin C for childhood glaucoma: a study of results with long-term follow-up. Clinics. 2008;63:421–426. doi: 10.1590/s180759322008000400002.

46. Elder MJ. Combined trabeculotomy-trabeculectomy compared with primary trabeculectomy for congenital glaucoma. Br J Ophthalmol. 1994;78:745–748.

47. Sadovnikova NN, Prisich NV, Brzheskij VV, Baranov AYu, Shilov AI. Drainage devices in glaucoma surgery in children. Modern technologies in ophthalmology. 2019;3:170–174 (In Russ.). doi: 10.25276/2312-4911-2019-3-170-174.

48. Chen A, Yu F, Law SK. Valved glaucoma drainage devices in pediatric glaucoma. Retrospective long-term outcomes. JAMA Ophthalmol/ 2015;133(9):1030–1035. doi: 10.1001/jamaophthalmol.2015.1856.

49. Pakravan M, Esfandiari H, Yazdani S, Doozandeh A. Clinical outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma. European journal of ophthalmology. 2018;1–8. doi: 10.1177/1120672118761332.

50. Gagrani M, Garg I, Ghate D. Surgical interventions for primary congenital glaucoma. Cochrane Database of Systematic Reviews. 2020;8:Art. No.: CD008213. doi: 10.1002/14651858.CD008213.pub3.

51. Bock CJ, Freedman SF, Buckley EG. Transscleral diode laser cyclophotocoagulation for refractory pediatric glaucomas. J Pediatr Ophthalmol Strabismus. 1997;34:235–239. doi: 10.3928/0191-3913-19970701-11.

52. Kirwan JF, Shah P, Khaw PT. Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas. Ophthalmology. 2002;109:316–323. doi: 10.1016/S0161-6420(01)00898-3.

53. Autrata R, Rehurek J. Long-term results of transscleral cyclophotocoagulation in refractory pediatric glaucoma patients. Ophthalmologica. 2003;217:393–400. doi: 10.1159/000073068.

54. Sood S, Beck AD. Cyclophotocoagulation versus sequential tube shunt as a secondary intervention following primary tube shunt failure in pediatric glaucoma. J AAPOS. 2009;13:379–383. doi: 10.1016/j.jaapos.2009.05.006.

55. Panova AYu, Katargina LA, Denisova EV, Sorokin AA. Immediate results of micropulse cyclophotocoagulation in glaucoma in children. Russian Pediatric Ophthalmology. 2022;17(3):21–29 (In Russ.).

56. Lazareva AK, Kuleshova ON, Ajdagulova SV, Chernyh VV. Peculiarities of childhood glaucoma: a review. National Journal glaucoma. 2019;18(2):102–112 (In Russ.). doi: 10.25700/NJG.2019.02.11.

57. Arestov DO, Hvatova AV. Comparative effectiveness of ultrasound and traditional trabeculectomy in congenital glaucoma in children. Russian Pediatric Ophthalmology. 2014;3:31 (In Russ.).

58. Katargina LA, Hvatova AV, Denisova EV. Efficiency of trabeculectomy with the use of cytostatics in the treatment of uveal glaucoma in children. Fyodorov Journal of Ophthalmic Surgery. 2002;3:37–40 (In Russ.).

59. National Guide to Glaucoma: for practicing physicians. 4th ed. Moscow: GJeOTARMedia, 2021:384 (In Russ.). doi: 10.33029/9704-5442-8-GLA-2020-1-384.

60. Arestova NN, Denisova EV, Katargina LA. Differentiated method of laser iridectomy for pupillary block in children with endogenous uveitis. Patent RU 2712299, 28.01.2020 (In Russ.).

61. Katargina LA, Arestova NN, Denisova EV. A method of YAG laser re-fistulization for blocking an internal fistula after sinustrabeculectomy in children with postuveal glaucoma. Patent RU 2633342С, 10.11.2017 (In Russ.).

62. Arestova NN. Results, indications and optimal timing of YAG laser reconstructive surgery of the anterior eye in children. Annals of Ophthalmology. 2009;125(3):38–45 (In Russ.).

63. Senft SH, Tomey KF, Traverso CE. Neodymium-YAG laser goniotomy vs surgical goniotomy. A preliminary study in paired eyes. Arch. Ophthalmol. 1989. 107(12):1773–1776. doi: 10.1001/archopht.1989.01070020855026.

64. Epstein DL, Melamed S, Puliafito CA. Neodymium-YAG laser trabeculopuncture in open-angle glaucoma. Ophthalmology. 1985;92(7):931–937. doi: 10.1016/S01616420(85)33932-5.

65. Arestova NN, Stepanov AV, Hvatova AV, Kodzov MB, Kruzhkova GV, Arestov DO. Method of laser treatment of terminal glaucoma in children with congenital aniridia and buphthalmos. Patent RU 2220691, 19.09.2002 (In Russ.).

66. Krasnov MM, Saprykin PI, Klatt A. Lasergonioplasty for glaucoma. Annals of Ophthalmology. 1974;2:30–34 (In Russ.).

67. Kozlov VI, Magaramov DA, Ereskin NN. Laser treatment of open-angle glaucoma with insufficient normalization of intraocular pressure after non-penetrating deep sclerectomy. Fyodorov Journal of Ophthalmic Surgery. 1990;4:62–66 (In Russ.).

68. Nesterov AP. Glaukoma. Moscow: MIA, 2008:360 (In Russ.).