EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/407647
EW FEATURE 48 Combined procedures for glaucoma November 2014 As a rule, Dr. Radcliffe finds that in conjunction with phacoemulsifi- cation, the intermediate procedures offer about the same level of pres- sure reduction. "You can hope these procedures will bring [pressures] into the mid-teens or that they'll take someone who has very high pres- sure into the high teens," he said. "We're still not reliably cracking that pressure of 30 or 40, you're going to get a 40% to 50% pressure reduction in IOP, whereas if you're starting at 22, it's going to be quite different," Dr. Francis said. While practitioners tend to shy away from using these procedures on those with higher pressures, "those patients can actually do well," Dr. Francis said. low-teen dream that we get with a traditional glaucoma surgery." However, by combining some techniques, patients may get a greater pressure-lowering effect, he said. One add-on technique that he has had success with combines the iStent, cataract removal, and ECP (known as ICE). "Most proce- dures work on the outflow pathway, with the near-singular exception of ECP," Dr. Radcliffe said. "From my standpoint that's what makes ECP the ultimate add-on procedure." In addition, doing ECP never prevents a practitioner from doing another procedure down the road, he said. He recently studied outcomes with ICE in 70 patients who under- went the procedure. Dr. Radcliffe found that while about 60% of patients were on 2 or more glauco- ma medications preoperatively, after undergoing ICE only about 30% of patients required this amount. Also, about one-third of patients experi- enced more than a 30% pressure reduction. However, there was an- other one-third of patients who did not experience much pressure lower- ing at all. But Dr. Radcliffe views ICE as a technique worth trying. "The way I think about it is [it's] exercis- ing a probability that we should not ignore because in that series of 70 patients, there were no complica- tions," Dr. Radcliffe said. Everyone did well with the cataract portion, so if 2 or 3 patients ended up needing additional glaucoma surgery, that is what they were looking at without ICE anyhow, he said. Overall, while these procedures cannot help everyone, Dr. Radcliffe is enthusiastic about the current surgical paradigm. "I think we're finally at an era where we have more options than ever to tailor therapy to best meet the life narratives of our patients," he said. "The more options we have to offer different patients, the more we're finally treating this disease in a way in which we can be proud." EW Editors' note: Dr. Francis has financial interests with AqueSys, Endo Optiks, and NeoMedix. Dr. Noecker has finan- cial interests with Glaukos and Endo Optiks. Dr. Radcliffe has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Glaukos, Iridex (Mountain View, Calif.), and Transcend Medical. Contact information Francis: BFrancis@doheny.org Noecker: noeckerrj@gmail.com Radcliffe: drradcliffe@gmail.com Now part of the Beaver-Visitec Family of Brands Beaver-Visitec International, Inc. | 411 Waverley Oaks Road Waltham, MA 02452 USA | BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of a Beaver-Visitec International ("BVI") company © 2014 BVI For more information, call 1.866.906.8080 or visit us at www.beaver-visitec.com * Francis, B., Berke, S., Dustin, L. and Noecker, R. (2014). Endoscopic cyclophotocoagulation combined with phacoemulsifi cation versus phacoemulsifi cation alone in medically controlled glaucoma. Journal of Cataract & Refractive Surgery, 40(8), pp.1313—1321. Now part of the Beaver-Visitec Family of Brands ECP added to cataract extraction resulted in greater reduction in IOP and glaucoma medications than cataract extraction alone over a 3 year period.* Introducing Endo Optiks® Endoscopic CycloPhotocoagulation (ECP) these procedures, Dr. Francis said. "You can have an average pressure reduction of about 20% to 30%," he said, adding that you also have the reduction offered by the glaucoma medications at the same time. The amount of pressure reduction all depends on the patient population. "If you use one of these procedures on a patient who starts out with a In the intermediate continued from page 47