Comparing endoscopic cyclophotocoagulation-plus (ECP-Plus) with anterior ECP for the treatment of refractory glaucoma

Abstract

Purpose : To investigate the efficacy and safety of a new endocyclophotocoagulation (ECP) procedure, ECP-plus, and compare this with anterior ECP for the treatment of refractory glaucoma.

Methods : This was a retrospective case series performed at an academic institution. A total of 58 eyes from 54 patients who underwent either anterior ECP or ECP-plus between 2011 and 2016 were included in the study. Twenty-five eyes were treated with ECP-plus and 33 eyes were treated with anterior ECP with two years of follow up. The primary outcome of the study was intraocular pressure (IOP). Secondary outcomes were best corrected visual acuity (BCVA), number of glaucoma medications required, success rate of the procedure, and post-procedural complications. Outcome measurements were compared between the two cohorts using linear mixed regression, adjusting for preoperative metrics such as degrees of the ciliary body treated, and combined ECP procedures with cataract surgery.

Results : Eyes that received ECP-plus had lower IOP (p = 0.023), used fewer number of glaucoma medications (p = 0.003), and achieved a higher success rate at two years postoperatively (p < 0.001). Additionally, the decrease in IOP between preoperative and last follow-up visits was significantly greater in the ECP-plus group compared to the anterior ECP group (-14.3 mmHg (52% reduction) vs. -5.2 mmHg (24% reduction), p = 0.001). The difference in complication rates between the ECP-plus and anterior ECP groups were not statstically significant (p = 0.561), and both groups maintained stable BCVA throughout the study.

Conclusions : Compared to anterior ECP, ECP-plus has a similar safety profile and may offer superior IOP control for the management of refractory glaucoma.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Average intraocular pressure (a), number of glaucoma medications (b), and BCVA (c) of anterior ECP and ECP-plus patients over the course of two years. Error bars are SEM. Empty circle represents anterior ECP and solid circle represents ECP-Plus.