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Adam Jordan Cantor, Jingyun Wang, Shanshan Li, Daniel Neely, David Plager; Long-term efficacy of endoscopic cyclophotocoagulation in the management of aphakic and pseudophakic glaucoma in children. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6474.
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© ARVO (1962-2015); The Authors (2016-present)
Endoscopic cyclophotocoagulation (ECP) has been effective in the management of a variety of difficult pediatric and adult glaucomas. This study reports long-term efficacy and safety of ECP as a primary surgical intervention in pediatric aphakic and pseudophakic glaucoma.
ECP was performed on 40 eyes of 28 patients under 16 years of age with aphakic or pseudophakic glaucoma. Patients were followed for 12 months minimum or until treatment failure, defined as postoperative intraocular pressure (IOP) of >24 mm Hg, IOP lowering of less than 15%, or occurrence of visually significant complications.
Success rate was 50.0% (20/40), with 62% receiving one treatment only. Pretreatment IOP averaged 34.4 ± 8.2 mmHg. Average total arc of treatment was 284 degrees. Final IOP after mean follow-up period of 6.6 years was 19.3 ± 8.6 (p <0.001). Patients with single ECP demonstrated significant improvement in visual acuity from baseline to most recent follow up. Risk factors for treatment failure include elevated IOP at first measurement following cataract extraction, at time of diagnosis of glaucoma, and baseline prior to ECP; increased patient age at time of ECP; and increased time between cataract extraction and ECP. Hypotony was not encountered.
ECP remains a successful tool in the treatment of aphakic and pseudophakic glaucoma, with a low rate of visually significant complications. Understanding of significant risk factors for treatment failure may help identify patients most likely to benefit from ECP. Unlike previous studies, failure was not increased in pseudophakic patients relative to aphakic patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Postoperative Intraocular Pressure
Risk Factors for Failure of ECP
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