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J.R. Boyd, D.L. Parver, A. Palestine; The Effectiveness of Pars Plana Vitrectomy with Endolaser Cyclophotocoagulation in Lowering Intraocular Pressure . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4648.
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To evaluate the effectiveness of endolaser cyclophotocoagulation (ECP) in lowering intraocular pressure (IOP) in patients with secondary open angle glaucoma. To examine if ECP reduces the need for IOP lowering medications.
This study was a retrospective review of 12 eyes (11 patients) with a diagnosis of secondary glaucoma that underwent ECP as a combined procedure with pars plana vitrectomy (PPV). All eyes were either pseudophakic or had a cataract extraction with implantation of a posterior chamber IOL as part of the surgical procedure. None of the eyes had glaucoma surgery (trabeculectomy or tube shunt) prior to ECP. ECP was delivered to 180 degrees of the ciliary body in 11 eyes and 240 degrees in 1 eye using an endolaser probe introduced through a sclerotomy site. A successful procedure was defined as an observed blanching of the ciliary processes. There were no intraoperative complications noted. The specific etiology of the secondary glaucoma included uveitic/inflammatory (9 eyes); steroid induced (1 eye); vitreous hemorrhage secondary to proliferative diabetic retinopathy (1 eye); and neovascular glaucoma secondary to retinopathy of prematurity (1 eye).
Mean follow–up after ECP was 12.2 months (range 3–29). Mean pre–operative IOP was 20.3 (10–34). Mean post–operative IOP was 14.6 (11–21) which was a reduction of 28% vs. pre–op levels. Patients used an average of 2.33 IOP lowering medications prior to ECP. The average number of IOP medications decreased to 2.00 after surgery which represents a 14% decrease in the number of IOP lowering medication needed after ECP. Patients were using IOP lowering medications (topical or oral) an average of 3.83 times/day prior to ECP. After surgery the mean number of medications used declined to 2.54 times/day which represents a 34% decrease. Visual acuity remained stable or improved in all eyes. There were no reports of phthisis. 2 eyes needed an additional transscleral cyclodestructive procedure during the follow–up period after ECP.
ECP is an effective method to lower intraocular pressure and can be used safely in pseudophakic patients undergoing PPV. There was a reduction of IOP in eyes undergoing ECP and there was a decrease in the number of IOP lowering medications required after ECP. In addition there was a decrease in the number of times/day needed to administer these medications.
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