Endoscopic cyclophotocoagulation in refractory glaucomas: a long term study

Abstract

Purpose: To evaluate the safety and efficacy of endoscopic cyclophotocoagulation (ECP) in the treatment of refractory glaucomas. Methods: The preoperative and postoperative courses of 539 eyes of 539 patients with refractory glaucoma who underwent ECP and had a minimum 5 years follow-up were retrospectively reviewed. All procedures were performed by a single surgeon (FEL). Eyes that were included had undergone at least one incisional glaucoma surgery and had intraocular pressure (IOP) equal to or above 35 mmHg on maximum tolerated medical therapy, and a visual acuity better than light perception. Success was defined as IOP greater than 6 mmHg and lower than 22 mmHg after 5 years postoperatively, with or without topical anti-hypertensive therapy. ECP included 210° of the ciliary body, corresponding to 2 to 9 hours in the right eye and from 3 to 10 hours in the left eye, including the anterior third of the pars plana. Results: The mean follow-up was 88.9 + 10.3 months (range 60 to 108 months). Mean preoperative IOP was 38.1 ± 6.5 mmHg, and postoperative IOP was 12.1 ± 3.4 mmHg, with or without topical antiglaucomatous medication (p<0.05). The mean number of glaucoma medications used by each patient was reduced from 3.9 + 1.2 preoperatively to 1.9 + 1.4 postoperatively (p< 0.05). Best corrected visual acuity was stable or improved postoperatively in 407 eyes (95.3%) while 20 eyes (4.7%) lost 2 or more lines of Snellen acuity. The success rate at 12 and 60 months were, 92.5% and 79% respectively. KaplanMeier survival analysis showed an overall probability of success at 60 months of 71.5%. Complications included fibrin exudation in 116 eyes (21.5%), hyphema in 58 eyes (10.7%), choroidal detachment in 31 eyes (5.7%), phthisis in 13 eyes (2.4%), retinal detachment in 8 eyes (1.4%) and hypotony in 7 eyes (1.2%).Conclusion: These results suggest that ECP is a safe and effective therapeutic modality for refractory glaucomas after a long-term follow-up.

High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction?

“…In advanced secondary glaucoma, the IOP reduction ranged from 26% to 68% (7 to 28 mmHg) or yielded a mean IOP decrease of 50% (18 mmHg) [ 70 , 71 , 74 – 76 ]. In the largest retrospective study on ECP (7.4 years of follow-up), Lima et al reported a postoperative IOP ranging between 6 and 21 mmHg in 79% of patients, with a mean number of medications of 1.9 [ 75 ].…”

The use of endoscopic cyclophotocoagulation for moderate to advanced glaucoma

“…Finally, congenital glaucoma has been noted in a retrospective study to have a high failure rate of 78% at 5 years after ECP (Lima et al. ).…”

“…In the single largest study ( n = 539), after 5 years, the IOP was between 6–21 mmHg in 79% of cases on an average of 1.9 medications (Lima et al. ).…”

Bullous choroidal detachment requiring drainage following endoscopic cyclophotocoagulation

“…On the contrary, 4 articles described choroidal detachment following ECP at a rate of 1%–5% ( Table 1 ). 5 – 8 In spite of that, none of these patients were reported to require choroidal drainage, as indicated in our case.…”

“…Review of the published results on the incidence of choroidal detachment following ECP. [5][6][7][8] Author (year)…”