COMPARING CYCLODIODE LASER THERAPY TO AHMED GLAUCOMA VALVE IMPLANTATION IN PEDIATRIC REFRACTORY GLAUCOMA

Abstract

Purpose: Glaucoma is a leading cause of irreversible blindness worldwide. Although less common in children, pediatric glaucoma is a serious condition that can impair visual development and cause permanent vision loss. Management is particularly challenging in refractory cases where intraocular pressure (IOP) remains uncontrolled despite medications and previous surgeries. Ahmed Glaucoma Valve (AGV) implantation has shown favorable outcomes, while cyclodiode laser therapy has produced variable results. However, direct comparisons between these treatments remain limited, especially in resource-limited settings. This study aimed to compare the safety and efficacy of AGV implantation and cyclodiode laser therapy after six months in refractory pediatric glaucoma patients.

Materials and Methods: This quasi-experimental study was conducted at the pediatric ophthalmology department of Al Ibrahim Eye Hospital, Karachi, with a six-month follow-up from November 2024 to April 2026. Eligible patients underwent either Ahmed Glaucoma Valve (AGV) implantation (Group A) or cyclodiode laser therapy (Group B). Patients with prior AGV or cyclodiode treatment and those lost to follow-up were excluded. Data were analyzed using SPSS.

Results: Among 76 pediatric patients, the AGV group achieved lower mean IOP at 6 months (16.0 vs. 20.2 mmHg, p=0.001), greater IOP reduction (52.9% vs. 40.2%, p=0.002), higher success rates (79.0% vs. 60.5%, p=0.031), and required fewer postoperative medications (p=0.012) than cyclodiode group, with similar complication rates.

Conclusion: Ahmed Glaucoma Valve implantation demonstrated statistically significant better results as compared to Cyclodiode Laser Therapy at 6 months in pediatric refractory glaucoma.