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Behzad Amoozgar, Max Feinstein, Jun Hui Lee, Kelsey Liu, Travis Porco, Jay M Stewart, Ying Han; Micropulse Transscleral Cyclophotocoagulation or MP-TCP VS Endoscopic Cyclophotocoagulation-Plus or ECP-Plus. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6101.
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To compare the long-term clinical outcomes between MP-TCP and ECP-plus.
In this retrospective study, we compared the clinical outcomes of 40 eyes of glaucoma patients who underwent MP-TCP with 25 eyes that underwent ECP-plus treatment. For MP-TCP we applied a transscleral Cyclo G6 laser (Iridex) with a P3 prob. Laser settings was 2000 mW with the duty cycle of 31.33%, which delivered over 180° for 80-160(S). For ECP-plus a 19-gauge endolaser was used with power set at 0.2-0.4 mW. The primary outcomes were change in intraocular pressure (IOP) and rate of failure. The secondary outcomes were rate of complication and best corrected visual acuity (BCVA). Data was collected in the last visit prior to the procedure and in 1, 3, 6, 12, and 18 months follow up visits. We defined a treatment failure criteria (description under Figure 1 ).
40 eyes of 33 patients (mean age 69) who received MP-TCP were compared with 26 eyes of patients underwent ECP-plus (mean age 61). Both the MP-TCP and ECP-plus approaches significantly reduced IOP compared to the baseline (Figure 1). When we compared the two groups via a linear mixed model while adjusting for the number of pre-op ocular medications, pre-op IOP value, BCVA (converted to LogMAR), and time from the procedure, ECP-plus had a significantly greater effect of reducing IOP compared to MP-TCP for all time points (Effect estimate=5.49, P < 0.001). Survival analysis showed a greater cumulative failure rate at 6 months in the ECP-plus group when compared to the MP-TCP (P < 0.001). However, during the 18 months follow up, 23 eyes in MP-TCP failed vs 6 eyes in ECP-plus and this difference was significant between two cohorts (P= 0.01). Using the mixed model, we did not find any difference between the two groups in regards to changes in BCVA (P= 0.63) (Figure 2). During the same follow-up period, 6 patients in ECP-plus group had complications while 4 of the patients in MP-TCP group showed complications (Table 2). There was no significant difference between two groups in regards to complication rate (P=0.1).
This study suggests that, compared to MP-TCP, the ECP-plus is more effective in lowering and controlling of IOP, while is related to the lower rate of failure during the 18-months of follow up. Comparing the rate of complication and BCVA, we did not find any significant differences between the two modalities.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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