Combined pars plana vitrectomy (PPV) / posterior endoscopic cyclophotocoagulation (ECP) versus combined phacoemulsification with intraocular lens placement (CEIOL) / anterior ECP in patients with glaucomatous comorbidities

Abstract

Purpose : To assess the safety and efficacy of combined PPV / posterior ECP compared to combined CEIOL / anterior ECP in patients with comorbid glaucoma.

Methods : A retrospective chart review of 22 eyes undergoing either combined PPV / posterior ECP by a single vitreoretinal surgeon (n=13) or combined CEIOL / anterior ECP by one of two glaucoma specialists (n=9) was conducted at a single tertiary academic medical center between January 1, 2017 and April 1, 2019. Each patient eye was followed for at least 6 months postoperatively. Primary outcomes were intraocular pressure (IOP, mm Hg) and number of prescribed glaucoma medications. Other variables of interest including demographics, type and severity of glaucoma, and number of ciliary body clock hours treated were analyzed via linear regression.

Results : While anterior and posterior groups were similar demographically, 9 of 13 eyes in the posterior group had neovascular glaucoma (NVG) and the anterior group had none. Although preoperative IOP was higher on average for the posterior group when compared to the anterior group (Posterior: 29.5±13.1; Anterior: 17.3±5.0; P=.007), both groups achieved similar average final IOP at 6 months (Posterior: 14.5±5.6; Anterior: 13.9±2.9; P= .76). While the initial number of prescribed glaucoma medications were equivalent (Posterior: 2.7±0.7; Anterior: 2.7±1.7; P=.96), the posterior group achieved a significantly lower medication burden than the anterior group at 6 months (Posterior: 1.1±1.2; Anterior: 2.3±0.7; P=.009). Regardless of approach, a greater number of clock hours of ECP treatment was associated with a greater reduction in both final IOP (P=.03) and number of prescribed glaucoma medications (P<.001). No cases in this series developed complications related to ECP, including hypotony (IOP less than 5 mmHg).

Conclusions : Combined PPV / posterior ECP and combined CEIOL / anterior ECP are both safe, effective methods to control IOP in patients with glaucoma. Despite treating sicker eyes, combined PPV / posterior ECP demonstrated a greater overall reduction of IOP and glaucoma medication burden than combined CEIOL / anterior ECP. As such, patients with comorbid recalcitrant or neovascular glaucoma undergoing a PPV may benefit from a vitrectomy combined with posterior ECP.

This is a 2020 ARVO Annual Meeting abstract.