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Kyle Marra, Sushant Wagley, Ahmed Omar, Jorge Arroyo; Functional and anatomic outcomes following endocyclophotocoagulation (ECP) surgery for neo-vascular glaucoma as compared to routine glaucoma care. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4485.
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To compare outcomes after treatment of neovascular glaucoma (NVG) with combination pars plana vitrectomy (PPV), endoscopic panretinal photocoagulation (PRP), and endocyclophotocoagulation (ECP) versus case-matched control patients with NVG who received routine glaucoma care.
In this retrospective, consecutive, age-matched study, all patients were seen at the Beth Israel Deaconess Medical Center with severe NVG. One group of patients were treated with PPV/PRP/ECP (ECP group, n=17) while another case-matched control group received routine glaucoma care (control group, n=18). Outcome measures included visual acuity, intraocular pressure (IOP), post-operative regression of iris neovascularization, complication rates, and the number of required anti-glaucoma medications.
Post-operative visual acuity deterioration by two or more lines was recorded in 11.1% of ECP cases and 11.8% of control cases. Mean IOP was significantly reduced (39.2 to 14.4 mmHg; p=0.005) within the ECP group while such significant reduction was not seen within the control group (30.8 to 22.7 mmHg; p=0.126). In case-matched between-group analysis, the IOP drop in the ECP group was also significant (p=0.013) when compared to the IOP drop in the control group. Disappearance of postoperative iris neovascularization was noted in the 80.0% of ECP cases versus 54.5% of control cases. The mean number of anti-glaucoma medications was also significantly reduced (3.1 to 0.9; p=0.003) within the ECP group, with no significant change within the matched cases of the control group (1.58 to 1.81; p=0.952). This change in number of glaucoma medications was significant (p=0.010) in between-group analysis of matched cases.
PPV followed by endoscopic PRP and ECP appeared to stabilize IOP more quickly and for a longer duration than other standard treatments for NVG. ECP also seemed to reduce the need for glaucoma medications better than other standard treatments for patients with NVG. These results suggest that more long-term investigation of ECP for NVG is warranted.
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