The use of endoscopic cyclophotocoagulation for moderate to advanced glaucoma

Abstract

ABSTRACT.Endoscopic Cyclophotocoagulation (ECP) is a glaucoma surgery designed to reduce the intraocular pressure (IOP) by partially ablating the ciliary processes to decrease aqueous humour production and secretion. The aim of this paper is to review the literature regarding the background, indications and results of the surgery. Although there are case reports of visually devastating complications, including persistent hypotony and phthisis, the use of ECP is often reported in eyes with advanced diseases. When compared with both trabeculectomy and aqueous shunt implantation, the visual outcomes were better with ECP while the IOP outcomes were very similar. The evidence supports ECP as a very effective surgical option in recalcitrant glaucoma while some evidence supports its safety for use as a primary procedure.

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

“…With respect to transscleral cyclophotocoagulation, which is reserved to intractable and advanced glaucoma, the endoscopic cyclophotocoagulation (ECP) is used also in nonrefractory cases, without absolute contraindications [71–73]. ECP has numerous advantages over transscleral cyclophotocoagulation, since the target tissue is directly visualized and, therefore, overtreatment is usually avoided.…”

“…In POAG, the IOP reduction was found to range from 18% to 47% (3.9 to 10.9 mmHg), with a mean IOP decrease of 31% (7 mmHg). 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 serious and potentially vision-threatening complications are less frequent in external cyclophotocoagulation and are represented by persistent hypotony (1–9%), phthisis (15 case reports), retinal detachment (1–6%), and vision loss or reduction (3–24%), especially in more advanced stages [71]. …”

Multicenter clinical trial of high‐intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

“…Depending on the population and forms of glaucoma treated, published studies usually report a comparable or slightly lower ability to reduce IOP. However, it should be mentioned that it might be hard to draw a comparison from previous studies, as the criteria for success are frequently different and, as the patients treated are in some of the studies performed with the diode laser cyclophotocoagulation, most have secondary and refractory glaucoma (Kaplowitz et al 2014). Similarly, systematic review or meta-analysis has described the ability of the filtering surgeries -particularly the trabeculectomy -to decrease IOP (Eldaly et al 2014;Zhou et al 2014).…”

Development of a biodegradable antifibrotic local drug delivery system for glaucoma microstents

“…Trabeculectomy and deep sclerectomy [6–8] have been used most commonly. Additionally, cyclophotocoagulation [9,10] provides an alternative therapy to lower IOP by decreasing the aqueous humor production.…”