ECP AT THE ASCRS, SAN DIEGO, 2007
Location:
SDCC
Time of Presentation: Apr 28 8:00 AM - 4:30 PM
Category:
P3 Glaucoma
Endoscopic Cyclophotocoagulation in Asian Patients
B. Lim1; L. W. Yip1
1. Department of Ophthalmology, The Eye Institute at Tan Tock Seng Hospital ,
Singapore, Singapore.
To report the safety and efficacy of endoscopic cyclophotocoagulation (ECP) for the
treatment of glaucoma in Asian patients.
This is a non randomised, retrospective study of consecutive cases by 1 surgeon in a
tertiary hospital. Records of patients who have undergone endoscopic
cyclophotocoagulation with or without cataract extraction and lens implant in the period
between Oct 2004 and May 2005 were traced. Diagnoses, indications for surgery, preoperation IOP, visual acuities, anterior chamber activity were recorded. Post operative
IOP, visual acuities, anterior segment examinations findings were recorded at 1 month,
3rd, 6th, 12th and 18th months. All had undergone 3 quadrants treatment.
Twenty eight eyes of 27 patients were included in the study. The mean age of the patients
was 74.4 years±9.9years(SD). The main categories of diagnoses were: POAG, 7(25%)
cases ;CACG, 7 (25%) cases, 3 (10.7%) cases of rubeotic glaucoma and 3 (10.7%) NTG.
Nineteen (67.9%) eyes underwent combined cataract extraction and ECP. Nine
eyes(32.1%) had ECP alone. Patients were followed up for 8.7± 4.4months. IOP reduced
from 22.4±6.0mmHg pre-operatively to 14.8± 5.1mmHg post operatively. This is
statistically significant. (p=0.004). Three(10.7%) patients had significant loss of visual
acuities of more than 2 lines on Snellen’s visual acuity chart. Three (10.7%) needed
further surgery for the control of glaucoma. There was no case of infection.
ECP is a safe and relatively effective procedure in lowering IOP in Asian glaucoma
patients. It may be considered in cases of failed transcleral cyclophotocoagulation. It is an
option in cases of external lids diseases where traditional trabeculectomy may pose a long
term threat of infection.
Location:
SDCC
Time of Presentation: Apr 28 8:00 AM - 4:30 PM
Category:
P3 Glaucoma
Comparison of IOP Control Between 1-site and 2-site Endoscopic
Cyclophotocoagulation After One-Year Follow-Up
M. Y. Kahook1; L. Camejo2; R. J. Noecker2
1. Ophthalmology, Rocky Mountain Lions Eye Institute, Aurora, CO, USA.
2. Ophthalmology, UPMC, Pittsburgh, PA, USA.
To report the IOP lowering effect of endoscopic cyclophotocoagulation (ECP) treatment
through one versus two corneal incisions after one year of follow-up.
This is a retrospective consecutive case review of combined ECP and
phacoemulsification (PE). Group 1 included patients undergoing PE-ECP through one
clear cornea incision and group 2 involved PE followed by ECP through two incisions.
Data including age, sex, pre-operative diagnosis, number of pre and post-operative
glaucoma medications, complications, treatment failures, and IOP were collected and
analyzed using analysis of variance (ANOVA) and t-tests where appropriate.
Group 1 included 18 patients and Group 2 included 30 patients. Age of patients in group
1 (68.30+/-15.52) and group 2 (72.78+/-13.22) were similar (p=0.29). Pre-operative IOP
was 25.60+/-3.51 in group 1 and 23.48+/-7.31 in group 2 (p=0.26). IOP decreased in
group 1 to 16.93+/-3.27 (p<0.001) and in group 2 to 14.12 +/-3.01 (p<0.001) with one
year of follow-up. IOP at one year was significantly lower in group 2 compared to group
1 (p=0.004). Post-operative glaucoma medication use was significantly lower in group 2
(2.81+/-0.83 to 0.67+/-0.39) versus group 1 (2.26+/- 0.91 to 1.90+/-0.73) (p<0.001).
Two-site PE-ECP may result in more statistically significant IOP lowering and less
dependence on glaucoma medications compared to single site PE-ECP after one year of
follow-up.
Location:
RM 24 C (SDCC)
Time of Presentation: May 01 1:02 PM - 1:07 PM
Category:
G2. Surgical Treatment
Long-Term Retrospective Study of Endoscopic Cyclophotocoagulation in
Refractory Glaucomas
F. E. Lima1, 2; D. M. Carvalho1; M. P. Avila1, 2
1. Centro Brasiliero de Cirurgi de Olhos, Goiania, Brazil.
2. Federal University of Goias, Goiania, Brazil.
To evaluate the safety of endoscopic cylophotocoagulation in the treatment of refractory
glaucomas.
539 eyes of 485 patients underwent one ECP and had a minimum 5 year follow-up
retrospectively reviewed. All eyes had IOP greater than 35 mmHg on maximum medical
therapy. Exclusion criteria included previous cyclodestructive procedure, NLP vision or
failed corneal graft. Success was defined as IOP between 5 and 22 mmHg at last followup. Limbal ECP was performed for 210 degrees with scleral depression of the ciliary
body. Results and complications were analyzed per mechanism of glaucoma.
Preop IOP was 37.9 +/- 6.4 mmHg and diminished to 15.7 +/- 8.5 mmHg (p=1.7 x 10188). Average number of surgeries preop was 2.2. Mean number of medications pre-op
was 3.9+/- 0.6 and postop was 1.5+/- 1.1 (p= 8.1 x 10-196). Success after 1 year was
92.6% and at 5 years was 78.8%. Complications included fibrin exudate 21.5%
(116/539), failed corneal graft 19.7% (13/66), hyphema 10.7% (58/539), immediate
postop IOP spike 9.8% (53/539), choroidal detachment 5.8% (31/539) phthisis 2.4%
(13/539), retinal detachment 1.5% (8/539), and hypotony 1.3% (7/539).
ECP is a highly effective approach for the long-term management of the most difficult
glaucoma patients with a wide margin of safety. These outcomes surpass the historical
results of tube implantation in this very large series with extended follow-up. ECP should
be considered as a first line treatment for refractory glaucoma.
Location:
RM 24 C (SDCC)
Time of Presentation: May 01 1:07 PM - 1:12 PM
Category:
G2. Surgical Treatment
Endoscopic Cyclophotocoagulation Versus Tube Implantation in Neovascular
Glaucoma: Prospective Randomized Long-Term Controlled Study
M. Uram1, 2
1. Retina Consultants, Little Silver, NJ, USA.
2. Manhattan Eye, Ear & Throat Hospital, New York, NY, USA.
To determine the relative efficacy and safety of ECP compared to Ahmed valve
implantation in the setting of neovascular glaucoma (NVG).
65 eyes of 65 patients were randomized by the statistician to treatment by ECP (34 eyes)
or Ahmed valve implantation (31 eyes). Assessment of pre- and post-operative acuity,
IOP, glaucoma medications, and complications were made. All eyes were pseudophakic.
Exclusion criteria included NLP vision and previous tube implantation or
cyclodestructive procedure. Success was defined as maintining IOP between 5 and 22
mmHg with or without medications.
Mean follow-up was 4.1 years (1.5 to 12.0). Pre-operative IOP was 40.3 +/- 3.1 mmHg
ECP and 41.7 +/- 3.4 mmHg valve (p=0.6). Post-operatively, IOP was 12.6 +/- 6.1
mmHg ECP and 15.2 +/- 8.9 mmHg valve (p=.0005). Number of pre-op meds ECP were
3.7 +/- 1.6 and 3.5 +/- 1.8 valve (p=0.7). Post-operatively this declined to 1.5 +/- 1.1 ECP
and 2.0 +/- 1.7 valve (p=.0005). Complications included visual loss 21% (7/34) ECP vs
26% (8/31) valve eyes, choroidal detachment 3% (1/34) ECP vs 23% (6/31) valve,
hypotony/phthisis 6% (2/34) ECP vs 13% (4/31) valve.
ECP demonstrated greater efficacy and safety then Ahmed valve implantation in this
long-term randomized controlled study.
ID#
Location:
RM 24 C (SDCC)
Time of Presentation: May 01 1:12 PM - 1:17 PM
Category:
G3. Laser Treatment
Endoscopic Cyclophotocoagulation in the Management of Uncontrolled Glaucoma
with Prior Aqueous Tube Shunt
B. A. Francis1; A. Kawji1; V. Chopra1
1. Glaucoma Service, Doheny Eye Institute, Los Angeles, CA, USA.
To evaluate the safety and efficacy of endoscopic cyclo-photocoagulation (ECP) in the
treatment of uncontrolled glaucoma with prior aqueous tube shunt.
This was a prospective, non-randomized, interventional clinical trial including 25 eyes of
25 consecutive glaucoma patients with a functional tube shunt and continued uncontrolled
intraocular pressure (IOP) despite additional medical therapy. A single application of ECP
over 360° was performed and subjects were followed for a minimum of six months.
Success was defined as a reduction in IOP of at least 3 mmHg with no additional
glaucoma medications. A failure was defined as continued uncontrolled IOP, with a
qualified failure as IOP > 21 mmHg. Patients with vision loss to the no light perception
(NLP) level and those requiring further glaucoma surgery other than ECP were also
considered failures.
At 24 months, the mean IOP dropped from 24.02 mmHg to 18.08 mmHg. The mean of
the differences was -5.61 mmHg, (-23.3%). The mean number of medications was 3.2
prior to laser, and 2 at 24 months. 96% of this study group achieved success at 1 month
post op (24/25) and 82% remained successful at the end of the follow-up period of 2 years
(p<.00005). There were no serious or devastating complications.
ECP is a safe and effective treatment in patients with uncontrolled IOP with a functional
tube shunt. It may be considered as a reasonable option in this group of refractory
patients.
Location:
RM 24 C (SDCC)
Time of Presentation: May 01 1:17 PM - 1:22 PM
Category:
G2. Surgical Treatment
Complications of Endoscopic Cyclophotocoagulation: ECP Collaborative Study
Group
R. J. Noecker1
1. University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
To define the safety profile of endoscopic cyclophotocoagulation (ECP) in the treatment
of glaucoma.
Review of prospectively collected data from a multicenter clinical trial. Complications
were tabulated for a large group of patients with an array of glaucoma mechanisms
treated with ECP by members of the ECP Collaborative Study.
5,824 patients treated and followed for 5.2 years (1 to 10.5). Early complications
included intraocular pressure (IOP) spike 14.5% (844 eyes), hyphema or vitreous
hemorrhage 3.8% (221 eyes), serous choroidal effusion 0.36% (21 eyes), and intraocular
lens displacement 0.36% (21 eyes). Long-term complications included cystoid macular
edema (CME) with visual loss 1.03% (54/5219 eyes), retinal detachment 0.27% (16
eyes), massive choroidal hemorrhage 0.09% (5 eyes), hypotony/phthisis and progression
to no light perception each occurred in 0.12% (7 eyes), and only in neovascular
glaucoma. Phakic patients developed cataract in 24.5% (261/1066). Chronic
inflammation, chronic pain, or infectious endophthalmitis, were not observed.
In this large group of patients with an array of glaucoma mechanisms, treated by various
surgeons and followed for an extensive period, ECP demonstrated a very low incidence
of complications. Safety of ECP compares favorably to data associated with
trabeculectomy and tube implantation, and far surpasses that of transcleral
cyclophotocoagulation.
Location: RM 24 C (SDCC)
Time of Presentation: May 01 1:22 PM - 1:27 PM
Category: G2. Surgical Treatment
Endoscopic Cyclophotocoagulation with Phacoemulsification in Medically
Controlled Glaucoma: Prospective Randomized Controlled Long-Term Study
M. S. McFarland1; T. Kirk2; S. H. Kirk3
1. McFarland Eye Center, Pine Bluff, AR, USA.
2. Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.
3. Kirk Eye Center, River Forest, IL, USA.
To determine if adding endoscopic cylophotocoagulation to phacoemulsification reduces
long-term need for glaucoma medications and/or IOP or increases risk of complications
compared to phacoemulsification alone and analyze Medication cost analyzed for each
group.
205 eyes were prospectively randomized by the statistician to phaco/ECP (127 eyes) or
phaco alone (78 eyes). Pre and postop IOP, medications and their costs, and
complications were recorded. Incidence of CME and complications were equal. Mean
follow-up was 3.1 years (0.33 – 6.33). Phacoemulsification with IOL insertion was
performed. Then a sodium hyaluronate viscoelastic was injected posterior to the iris but
anterior to the lens capsule, inflating the sulcus. The laser endoscope was inserted and
270 – 360 degrees of the ciliary ring were treated using an 810nm diode laser with power
ranging between 200 – 500 mw with continuous wave duration.
Preop IOP was 22.8 +/- 5.5 mmHg and diminished to 16.1 +/- 3.2 mmHg postoperatively
(p= 9.63 x 10-27). In phaco alone pre-op IOP was 18.2 +/- 3.4 mmHg and decreased to
17.9 +/- 4.3 mmHg (p= .18). Mean number of glaucoma medications was 1.6 +/- 1.1 in
the phaco/ECP arm, decreasing to 0.8 +/- 1.0 (p= 5.26 x 10-17) postoperatively. Mean
number of pre-treatment medications in the phaco alone group was 1.2 +/- 0.8 and 1.2 +/0.9 (p= 0.5) postoperatively. Phaco/ECP patients spent $910.48 less per year on
medications. Control patients spent $56.47 per year more.
Adding ECP to phaco resulted in a significant long-term decrease in IOP, need for
medications, and expense. Phaco alone did not confer a long-term benefit; neither
decreasing IOP or medications. The option of adding ECP to phaco might be considered
the treatment of choice in this large patient population.