Endocyclophotocoagulation by pars plana approach in the management of refractory glaucoma with prior phacoemulsification and Ahmed gonioimplantation in a dog

Abstract

Purpose To describe successful intraocular pressure control of refractory glaucoma and vision preservation with an endocyclophotocoagulation (ECP) procedure by pars plana approach. Animal Studied An 8‐year‐old, female‐spayed, mixed‐breed goniodysgenic dog with glaucoma following phacoemulsification with intraocular lens placement (IOL) refractory to maximized medical therapy and Ahmed gonioimplantation in both eyes (OU). Procedures For the first glaucoma interventional surgery, bilateral goniovalve implantation was performed following cataract surgery. A goniovalve was implanted in the left eye (OS) 2‐days post‐phacoemulsification, and 14‐days post‐phacoemulsification in the right eye (OD). Short‐term intraocular pressure (IOP) control was achieved. However, glaucoma recurred 41‐days post‐phacoemulsification OU, and an endocyclophotocoagulation by pars plana approach was performed OU to treat 300° of the ciliary body with a 23‐gauge argon laser endoscope. Results Th ECP pars plana approach was successful in obtaining IOP‐control and vision preservation during a 15‐month follow‐up period. No intraoperative complications were encountered. Short‐term postoperative complications included intraocular inflammation with fibrin and postoperative ocular hypertension. Intraocular pressure‐control and vision preservation were maintained at the last follow‐up examination, 15 months postoperative pars plana ECP. Conclusion Endocyclophotocoagulation by pars plana approach achieved long‐term (>1 year) IOP‐control, preserved vision, and reduced the number of anti‐glaucoma medications following failure of previous Ahmed gonioimplantation for uncontrolled glaucoma. This is the first case report of an endocyclophotocoagulation procedure by a pars plana approach for uncontrolled glaucoma following Ahmed gonioplantation. With the appropriate skill set, this novel surgical approach can be considered as a surgical intervention for glaucoma in canine patients.