Long-term Outcome of Cyclocryotherapy for Refractory Pediatric Glaucoma Nikhil S. Wagle, MD, 1 Sharon F. Freedman, MD, 1 Edward G. Buckley, MD, 1 John S. Davis, MD, 2 Albert W. Biglan, MD 2 Objective: To evaluate the success rate and long-term outcome of cyclocryotherapy for refractory pediatric glaucoma. Design: Retrospective interventional case series. Participants: A total of 64 eyes of 49 patients from 2 institutions with pediatric glaucomas resistant to conventional medical and surgical therapies treated with cyclocryotherapy from 1975 to 1996 were included in this review. Intervention: Cyclocryotherapy was performed on eyes with pediatric glaucoma resistant to maximal medical and surgical interventions. Each cyclocryotherapy session was evaluated in terms of area treated, temperature, and number of applications placed. Main Outcome Measures: Criteria for success included intraocular pressure (IOP) of 21 mmHg or less without devastating complications or need for further glaucoma surgery. Results: The mean baseline pretreatment IOP of all eyes was 30.0  8.1 mmHg. Six months after their last treatment, 42 eyes (66%) were successes. Longer term follow-up (mean, 4.8  3.3 years) yielded a lower final success rate in 28 eyes (44%). For these 28 eyes, mean IOP was reduced from 30.3  7.8 mmHg pretreatment to 16.8  4.0 mmHg after their last cyclocryotherapy treatment session (P  0.001). The average number of cyclocryotherapy sessions for successful eyes was 4.1  4.0 (range, 1–17). The mean follow-up time for these successful eyes was 4.9  3.4 years. Devastating complications attributable to cyclocryotherapy included phthisis (5 eyes) and retinal detachment (5 eyes). Devastating complications occurred more frequently among eyes with aniridia than among all other eyes (nonaniridics) (50% vs. 11%, respectively; P  0.05). Conclusion: Cyclocryotherapy is an effective means of lowering IOP and is a reasonable treatment option in selected pediatric patients with refractory glaucoma. Eyes with aniridia experienced a very high rate of phthisis after cyclocryotherapy and may be poor candidates for this treatment. Ophthalmology 1998;105:1921–1927 Cyclodestructive procedures have generally been reserved for cases of pediatric glaucoma resistant to other methods of treatment. These methods include angle, filtration, and glau- coma implant surgery, as well as medical treatment. Cy- clodestructive procedures have taken many different forms and include cyclocryotherapy and, more recently, trans- scleral and endoscopic cyclophotocoagulation. Cyclocryotherapy was initially shown to reduce intraoc- ular pressure (IOP) by Bietti 1 in 1950. However, it did not gain popularity until the late 1960s, when de Roetth 2 re- ported a success rate of 73% with cyclocryotherapy for 165 adult patients with uncontrolled IOP. Currently, in adults, this procedure is reserved for end-stage or very refractory glaucoma. Because of variable success in adults (34%– 92%) and significant postoperative pain and complications including phthisis and retinal detachment, trans-scleral neodymium:YAG (Nd:YAG) and diode lasers are replacing cyclocryotherapy as the preferred form of cyclodestruction in these eyes. 3–9 In the pediatric population, there have been few studies analyzing the relative merits of cyclocryotherapy and laser cyclodestructive procedures. In 1973, Bellows and Grant 10 reported a success rate of 38.5% using cyclocryotherapy in 13 eyes with refractory glaucoma of various types. In 1981, Aminlari 11 noted a success rate of 18% when cyclocryo- therapy was used as the initial treatment for patients with primary congenital glaucoma. In 1990, al Faran et al 12 reported an overall success rate of 30% for the use of cyclocryotherapy in patients with this same diagnosis. Phelan and Higginbotham 13 reported a 50% success rate with trans-scleral Nd:YAG laser cyclophotocoagulation in children with refractory pediatric glaucomas of primary and secondary types. Bock et al 14 reported a 50% success rate using trans-scleral diode laser cyclophotocoagulation in children with refractory glaucomas of various types. To date, we are aware of few published studies regarding the effectiveness of cyclocryotherapy for refractory primary Originally received: October 27, 1997. Revision accepted: May 19, 1998. Manuscript no. 97621. 1 Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina. 2 University of Pittsburgh, Department of Ophthalmology, Pittsburgh, Pennsylvania. Presented in part at the American Academy of Ophthalmology annual meeting, San Francisco, California, October 1997. The authors have no proprietary interest in the development or marketing of the instruments used in this study. Reprint requests to Sharon F. Freedman, MD, Box 3802, Duke University Eye Center, Erwin Road, Durham, NC 27710. 1921