Eyeworld

EW GLAUCOMA 70 November 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer process, which causes a decrease in the amount of intraocular fluid produced due to inflammation and scarring of the tissues. Epithelial regeneration necessitates multi- ple treatments in some patient to achieve the desired lasting IOP-low- ering effects. A study presented at the 2017 ASCRS•ASOA Symposium & Con- gress revealed that ECP was a safe procedure that provided adequate IOP lowering in 50 patients with medically uncontrolled glaucoma. During the 2-year follow-up period, IOP and visual acuity were stable, and there was a low complication rate. "ECP can be performed alone or in combined surgery," said Juan Staunching aqueous production with endocyclophotocoagulation helps pressure reduction in dire glaucoma cases P atients with refractory glaucoma or individuals who are poor candidates for filtration surgery or pressure reducing implants have the option to undergo endo- cyclophotocoagulation (ECP), an approach that has been used over the decades to help reduce IOP. ECP is often implemented together with cataract surgery, involving coagula- tion of the epithelium of the ciliary Carlos Izquierdo Villavicencio, MD, chief of glaucoma, Oftalmosa- lud Eye Institute, Lima, Peru, who presented the study. "It is an effec- tive treatment in refractory glauco- mas with a high success rate for the control of intraocular pressure. The persistence of the pressure-lowering effects of ECP over cataract surgery alone was shown." The retrospective longitudinal interventional study involved 50 eyes in 39 patients (mean age 65 ± 16.25 years), of which 24 were male (38.5%) and 15 were female (61.5%), who underwent cataract surgery with ECP between 2011 and 2013 at the Oftalmosalud Eye Institute. All patients had refractory glaucoma, of which the majority had chronic open angle glaucoma (76%), 15% had post-keratoplasty glaucoma, 4% had narrow angle glaucoma, 2% had uveitis-related glaucoma, and anoth- er 2% had neovascular glaucoma. Dr. Izquierdo Villavicencio looked at postoperative changes in IOP, visual acuity, reduction of glaucoma medications, and surgical complications through 2 years of follow-up. The surgical success was defined as a maximum IOP of 21 mm Hg and a minimum IOP of 6 mm Hg, with or without anti-glau- coma drugs. The mean preoperative IOP was 22.3 ± 8.73 mm Hg. On the first postoperative day, IOP was reduced to 14.94 ± 6.30 mm Hg, with pressures stabilizing here and continuing to decrease over 2 years. Small changes in IOP were noted in the postop period at 1 month: 14.80 ± 5.57 mm Hg, 6 months: 14.28 ± 4.65 mm Hg, 1 year: 14.28 ± 4.01 mm Hg, and 2 years: 13.02 ± 4.61 mm Hg. Dr. Izquierdo Villavicencio observed that the difference in IOP reductions was significant from the preoperative measurement to 2 years of follow-up (P=.00). The mean best corrected visual acuity was 0.86 ± 0.81 D preop- eratively. On day 1, best correct- ed vision was 1.24 ± 0.89 D, at 1 month BCVA was 0.86 ± 0.93 D, at 6 months it was 0.77 ± 0.99 D, at 1 year it was 0.73 ± 0.99 D, and at 2 years it was 0.74 ± 1.02. Dr. Izquier- do Villavicencio noted a significant difference in the preoperative versus postoperative day 1 visual acuity (P=.00), and no significant difference 2 years after surgery (P=.140). He said that anti-glaucoma drug treatments decreased from 2.08 ± 0.87 medications used per patient preoperatively to 1.86 ± 0.92 medications at 1 year and to 1.60 ± 0.94 medications at the 2-year time point. The difference between the number of drugs taken by patients preoperatively and at 2 years was statistically significant (P=.016). Complications of ECP can include hyphema, hypotony, fibrin exudates, cystoid macular edema, and decreased visual acuity. As the procedure employs the use of an intraocularly inserted probe, the surgeon needs to be particularly vigilant not to damage the anterior lens capsule or the iris root. Regen- eration of the ciliary epithelium has been known to trigger a rise in IOP, making it necessary to repeat treat- ment to maintain the desired long- term pressure-lowering effects. In the current study, 82% of the study participants had no complications related to the surgical intervention. Of the remaining patients, there was failure of valve treatment in 12%, corneal rejection in 2%, choroidal detachment in 2%, and hemorrhagic choroidal detachment in 2%. In a 4-year study that investi- gated the persistence of the pres- sure-lowering effect of ECP in 707 medically controlled glaucoma patients undergoing cataract surgery, investigators found that at 2 years postoperatively, 79% of eyes that had phaco/ECP had decreased IOP, no change was seen in 9%, and an increase in IOP was noted in 12%. In the phaco only eyes, 38% had pressure reductions 2 years after sur- gery, no change was seen in 2%, and an increase in IOP was observed in Endocyclophotocoagulation in refractory glaucoma Dr. Izquierdo Villavicencio performs ECP with direct monitor visualization of surgical endpoints. Source: Juan Carlos Izquierdo Villavicencio, MD Presentation spotlight continued on page 72

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