The safety and efficacy of CO 2 laser-assisted sclerectomy surgery-based multi- pathway glaucoma surgery in intractable pediatric glaucoma

Abstract Background To evaluate the safety and efficacy of CO2 laser-assisted sclerectomy surgery (CLASS)-based multi-pathway glaucoma surgeries in intractable pediatric glaucoma. Methods Retrospective, self-controlled, interventional case series. Twenty-three intractable pediatric glaucoma patients (26 eyes) who underwent CLASS-based multi-pathway surgeries were enrolled, including CLASS combined with trabeculectomy and CLASS combined with combined trabeculectomy and trabeculotomy. Complete examinations were performed before and after surgery. Intraocular pressure (IOP) change, complete and qualified success rates (CSR, QSR), best-corrected visual acuity (BCVA), number of IOP-lowering eyedrops and adverse events were recorded. Results The mean age at surgery was 8.72 ± 5.46 years and the mean follow-up time was 25.49 ± 10.87 months. Baseline IOP, number of IOP-lowering eyedrops and logMAR BCVA were 32.00 ± 4.83 mmHg, 3.21 ± 0.71 and 1.31 ± 0.90 respectively. The mean IOP was 12.05 ± 5.02, 11.71 ± 3.25 and 12.67 ± 3.38 mmHg at 6 months, 1 year and 2 years after surgery, which were significantly lower than baseline (all p < 0.05). The reduction in number of medications was statistically significant at all post-operative timepoints within 3 years (all p < 0.005). CSR and QSR were 82.2% and 91.7% respectively at 1 year, and were 68.5% and 81.5% respectively at 2 years. Majority of the early and late-onset complications including shallow anterior chamber, extensive peripheral anterior synechia, scarring of blebs and cataract were mild and reversible. Conclusion CLASS-based multi-pathway surgery was safe and effective for the treatment of intractable pediatric glaucoma. It is promising to become an alternative and safer surgical management for intractable pediatric glaucoma.