Abstract
Purpose
To examine how indications, patient characteristics, and outcomes differ between anterior and posterior approaches of endoscopic cyclophotocoagulation (ECP) in the treatment of glaucoma.
Methods
This is a retrospective chart review of 9 anterior and 20 posterior ECP cases (n = 29).
Results
Posterior ECP cases were typically associated with a dramatic increase in intraocular pressure (IOP), whereas the anterior ECP was associated with chronically elevated pressures. The initial IOPs in mm Hg of posterior ECP cases (26.8 non-NVG; 35.2 NVG) were much greater than anterior ECP cases (17.8), and a greater overall reduction in IOP was observed in the posterior versus anterior ECP cases (10.3 posterior non-NVG; 21.3 posterior NVG; 3.6 anterior, P < .001). With procedural success defined as 6-month post-operative IOP falling within normal ranges and a decrease in either IOP or number of prescribed glaucoma medications, the success rate of ECP was 92% for posterior NVG, 89% for anterior and 75% for posterior non-NVG cases (P = .34), similar to the previous literature. Of the four unsuccessful cases, two resulted in a normal IOP but lacked a drop in pressure or reduction in medication burden, one resulted in a 6-point drop in IOP but remained at 23 mm Hg, and one resulted in phthisis bulbi (3%) from an initial pressure above 40 mm Hg.
Conclusion
Endoscopic cyclophotocoagulation is an effective and safe procedure for severe glaucoma cases from both an anterior and posterior approach. Ophthalmologists should consider this procedure as part of their glaucoma treatment arsenal.
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Data availability
Data are available from the corresponding author upon request.
References
Tham Y-C, Li X, Wong TY et al (2014) Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121:2081–2090. https://doi.org/10.1016/j.ophtha.2014.05.013
Chang EE, Goldberg JL (2012) Glaucoma 2.0: neuroprotection, neuroregeneration, neuroenhancement. Ophthalmology 119:979–986. https://doi.org/10.1016/j.ophtha.2011.11.003
Tatham AJ, Weinreb RN, Medeiros FA (2014) Strategies for improving early detection of glaucoma: the combined structure–function index. Clin Ophthalmol Auckl NZ 8:611–621. https://doi.org/10.2147/OPTH.S44586
Li T, Lindsley K, Rouse B et al (2016) Comparative effectiveness of first-line medications for primary open-angle glaucoma: a systematic review and network meta-analysis. Ophthalmology 123:129–140. https://doi.org/10.1016/j.ophtha.2015.09.005
CNTGS Group (1998) Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol 126:487–497. https://doi.org/10.1016/S0002-9394(98)00223-2
Gedde SJ, Feuer WJ, Shi W et al (2018) Treatment outcomes in the primary tube versus trabeculectomy study after 1 year of follow-up. Ophthalmology 125:650–663. https://doi.org/10.1016/j.ophtha.2018.02.003
Richter GM, Coleman AL (2016) Minimally invasive glaucoma surgery: current status and future prospects. Clin Ophthalmol Auckl NZ 10:189–206. https://doi.org/10.2147/OPTH.S80490
Lin S (2002) Endoscopic cyclophotocoagulation. Br J Ophthalmol 86:1434–1438. https://doi.org/10.1136/bjo.86.12.1434
Solano MM, Huang G, Lin SC (2017) When should we give up filtration surgery: indications, techniques and results of cyclodestruction. Glaucoma Surg 59:179–190. https://doi.org/10.1159/000458496
Lin SC (2008) Endoscopic and transscleral cyclophotocoagulation for the treatment of refractory glaucoma. J Glaucoma 17:238–247. https://doi.org/10.1097/IJG.0b013e31815f2539
Clement CI, Kampougeris G, Ahmed F et al (2013) Combining phacoemulsification with endoscopic cyclophotocoagulation to manage cataract and glaucoma. Clin Exp Ophthalmol 41:546–551. https://doi.org/10.1111/ceo.12051
Francis BA, Berke SJ, Dustin L, Noecker R (2014) Endoscopic cyclophotocoagulation combined with phacoemulsification versus phacoemulsification alone in medically controlled glaucoma. J Cataract Refract Surg 40:1313–1321. https://doi.org/10.1016/j.jcrs.2014.06.021
Marra KV, Wagley S, Omar A et al (2015) Case-matched comparison of vitrectomy, peripheral retinal endolaser, and endocyclophotocoagulation versus standard care in neovascular glaucoma. Retina Phila Pa 35:1072–1083. https://doi.org/10.1097/IAE.0000000000000449
Marra KV, Yonekawa Y, Papakostas TD, Arroyo JG (2013) Indications and techniques of endoscope assisted vitrectomy. J Ophthalmic Vis Res 8:282
Tan JCH, Francis BA, Noecker R et al (2016) Endoscopic cyclophotocoagulation and pars plana ablation (ECP-plus) to treat refractory glaucoma. J Glaucoma 25:e117-122. https://doi.org/10.1097/IJG.0000000000000278
Feinstein MA, Lee JH, Amoozgar B, et al (2019) Comparison between pars plana and anterior endoscopic cyclophotocoagulation for the treatment of glaucoma. Clin Exp Ophthalmol. https://doi.org/10.1111/ceo.13501
Kahook MY, Lathrop KL, Noecker RJ (2007) One-site versus two-site endoscopic cyclophotocoagulation. J Glaucoma 16:527–530. https://doi.org/10.1097/IJG.0b013e3180575215
Lindfield D, Ritchie RW, Griffiths MF (2012) “Phaco-ECP”: combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma. BMJ Open. https://doi.org/10.1136/bmjopen-2011-000578
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BS was involved in conception, design, and data acquisition, analyzed the data, and drafted the manuscript. MS was involved in design and data acquisition, analyzed the data, and revised the manuscript. CAL analyzed the data and revised the manuscript. JGA was involved in supervision and conception and revised the manuscript.
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Seto, B., Singh, M.K., Lemire, C.A. et al. Anterior versus posterior endoscopic cyclophotocoagulation: comparison of indications, populations, and outcomes. Int Ophthalmol 41, 3021–3028 (2021). https://doi.org/10.1007/s10792-021-01863-5
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DOI: https://doi.org/10.1007/s10792-021-01863-5