Endoscopic photocoagulation of the ciliary body after repeated failure of trans-scleral diode-laser cyclophotocoagulation.

PURPOSE: To report the successful control of intraocular pressure with endoscopic cyclophotocoagulation after repeated failure of trans-scleral diode-laser cyclophotocoagulation.
DESIGN: Interventional case report.
METHODS: A 3 1/2-year-old child had intraocular pressure around 30 mm Hg in one eye despite full medical treatment and three procedures of trans-scleral diode laser photocoagulation.
RESULTS: Endoscopic view of the ciliary body revealed many misplaced laser burns in the pars plana region. Using direct endoscopic visualization of the ciliary body, precise, confluent burns were applied to the ciliary body. Six months after the procedure, intraocular pressure has remained under 20 mm Hg.
CONCLUSION: Endoscopic cyclophotocoagulation can effectively lower intraocular pressure after recurrent external diode-laser photocoagulation has failed to do so. The direct visualization during the endoscopic procedure is particularly advantageous in cases with atypical ciliary body morphology, such as in pediatric glaucoma.