Children’s First In State to Perform Pediatric Endolaser Procedure

from The Children's Hospital (TCH) News, April 2005

The Children's Hospital performed the first pediatric
endolaser procedure in the state in December.

Although glaucoma is commonly associated with older adults, in children it’s much more serious – most children with the condition go blind – and more difficult to treat, said Arlene Drack, MD, The Children’s Hospital’s chief of ophthalmology.

Glaucoma is caused by an elevation in pressure inside the eye that results from a buildup of excess fluid. It’s very rare in children and develops in one of 10,000 children. Most adults develop the condition as their eyes change with age or as a response to trauma, but glaucoma in children occurs because their eyes did not form normally in utero.

Most adults with the condition can treat it with eye drops, Dr. Drack said, but a small percentage need surgery. However, nearly all children need surgery.

“Most surgeries for children are a modification of adult procedures, and they don’t work as well,” she said. “The pediatric eye has different responses to surgery.”

For example, a common procedure for glaucoma in both adults and children uses a laser to cut tiny incisions in the eye to drain some of the fluid to release the pressure. But children’s eyes tend to heal faster and close the incisions, Dr. Drack said.

In another procedure, an ophthalmologist places a laser with a camera on the end on the surface of the eye to see inside and find the structures that make the fluid – often there are too many – and decrease the number.

“This works well in adults, but in children, the eye is abnormally formed, and those structures are not in the right place,” Dr. Drack said.

But recently a new procedure – called endolaser – has shown promise for treating children with glaucoma, Dr. Drack said. In this procedure, the ophthalmologist cuts a small incision in the eye and inserts a probe with a laser and camera inside.

“You can see the structures that make the fluid and decrease the amount of fluid the eye is making,” she said. “It’s a much better treatment for the way a child’s eye works.”

Children’s sees a number of patients with glaucoma, she said, but until recently had to send them to the University of Indiana for this procedure. But that changed last year when Dr. Drack and ophthalmologist Rebecca Sands, MD, went to the Indiana center to observe the procedure on a Children’s patient. Drs. Drack and Sands became certified to work with the laser, and in December, Children’s performed the first pediatric endolaser procedure in Colorado.

Dr. Drack performed that procedure using rented equipment, but Children’s recently purchased its own laser; five more children are scheduled for the procedure in the next few weeks.

“This type of laser is only available for kids at a few centers in the country,” Dr. Drack said. “Now, instead of sending our patients to Indiana – the next-closest center – the kids who need the procedure can get it here.”

The procedure has fewer side effects than other surgeries, including less risk of long-term severe infection inside the eye, she said. The recovery time also is also quicker than other procedures, she said.

Although Children’s is currently only performing the procedure on children with aphakic glaucoma – children who have a cataract or have had cataract surgery – Dr. Drack hopes The Children’s Hospital soon will be able to treat children with other types of glaucoma as well.

“There’s a big need for this procedure here,” she said. “Half of the children who get this treatment will require a second procedure. Now if a child needs further treatment, we can do it here.”