Main Article Content
Purpose: To investigate the efficacy, survival time and safety profile of endoscopic cyclophotocoagulation (ECP) in patients with failed primary glaucoma drainage device (GDD).
Material and methods: A retrospective case review of ten patients with primary GDD implantation who underwent ECP from July 2013 to April 2018. Ten eyes of 10 patients were included. Indication of ECP was failure to achieve target IOP with maximal tolerated medical therapy despite the GDD implantation. ECP were performed by a single surgeon over at least 270 degrees and the subjects were followed up to 1 year. Main outcome measures were mean reduction in IOP and anti-glaucoma medications at 1, 3, 6 and 12 months. The visual acuity and complications were also documented.
Results: Mean IOP at baseline, 1, 3, 6 and 12 months were 17.7 + 3.74 mmHg, 18.1 + 8.1 mmHg, 18.1 + 6.1 mmHg, 16.5 + 5.9 mmHg, and 15.2 + 4.8 mmHg respectively. Although the IOP post ECP was in the downwards trend, it was not statistically significant (p=0.916). Mean difference in number of anti-glaucoma medications were 1.40, 1.44, 1.38, and 1.5 at baseline, 1, 3, 6 and 12 months respectively, which was statistically significant up to 6 months (p=0.036). One patient required repeat ECP due to uncontrolled high IOP and another had recurrent rhegmatogenous retinal detachment. No other complications encountered.
Conclusion: ECP is a useful and safe surgery in managing refractory glaucoma with inadequate IOP control post primary GDD implantation.
Conflict of Interest: There is no conflicting relationship exists for any author
2. Wang MY, Patel K, Blieden LS, Chuang AZ, Baker LA, Bell NP, et al. Comparison of Efficacy and Complications of Cyclophotocoagulation and Second Glaucoma Drainage Device After Initial Glaucoma Drainage Device Failure. J Glaucoma. 2017 Nov;26(11):1010-8.
3. UramM. Endoscopic cyclophotocoagulation in glaucoma management. Curr Opin Ophthalmol. 1995;6(2):19-29.
4. Lindfield D, Ritchie RW, Griffiths MF. Phaco-ECP: combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma. BMJ Open. 2012;2:1-6.
5. Siegel MJ. Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma. Clin Exp Ophthalmic. 2015;43:531-9
6. Francis BA, Kawji AS, Vo NT, Dustin L, Chopra V. Endoscopic cyclophotocoagulation (ECP) in the management of uncontrolled glaucoma with prior aqueous tube shunt. J Glaucoma 2011;20:523-7.
7. Murakami Y, Akil H, Chahal J, Dustin L, Tan J, Chopra V, et al. Endoscopic cyclophotocoagulation versus second glaucoma drainage device after prior aqueous tube shunt surgery. Clin Exp Ophthalmol. 2017 Apr, 45(3):241-6.
8. Lima FE, Magacho L, Carvalho DM, Susanna RJ, Avila MP. A prospective, comparative study between endoscopic
cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma. J Glaucoma. 2004;13:233-7.
9. Gayton JL, VanDer KM, Sanders V. Combined cataract and glaucoma surgery: trabeculectomy versus endoscopic laser cycloablation. J Cataract Refract Surg. 2000;26;330-6.
10. Clement C. Combining phacoemulsification with endoscopic cyclophotocoagulation to manage cataract and glaucoma. Clin Exp Ophthalmic. 2013;41:546-661