Primary Open-Angle Glaucoma Preferred Practice Pattern®.

Cyclophotocoagulation: A report by the American Academy of ophthalmology

Purpose Cyclophotocoagulation (CPC) is traditionally used in cases of glaucoma that are refractory to medical and surgical therapy. The goal of this review is to provide an update on the methods, efficacy, complications, indications, and histopathology of transscleral and endoscopic CPC. Methods A literature review was conducted for transscleral and endoscopic CPC. Relevant studies were included for evaluation of the procedures. Results For transscleral CPC (TCP), there is a wide range of success rates reported in the literature, depending on energy settings, follow-up period, and definitions of success. Repeat TCP is often required. Serious complications have included significant vision loss, hypotony, and phthisis. TCP has mostly been performed in very severe forms of glaucoma, in eyes with limited visual potential, or after filtration surgery has failed, although more recently TCP has been used as a primary surgery in eyes with good visual potential. There are more limited published results on endoscopic CPC (ECP), which have demonstrated overall good success. Complication rates are relatively low with ECP, however, large studies with long-term follow-up are lacking. ECP has also been used in difficult, refractory cases, but often used earlier when combined with cataract surgery. Conclusions Both TCP and ECP are effective surgeries with potential for serious complications. Recent studies suggest they may be used increasingly as the primary surgery for various stages of glaucoma.

Endoscopic and transscleral cyclophotocoagulation for the treatment of refractory glaucoma.

Introduction: Experience with endoscopic diode laser cyclophotocoagulation remains limited. We report the efficacy and safety profile of this glaucoma surgery technique in the pediatric population. Methods: Retrospective review of 51 endoscopic diode laser cyclophotocoagulation procedures performed on 36 eyes of 29 pediatric patients with glaucoma over a 6-year period. Surgery was performed by using the Microprobe (Endo Optiks, Little Silver, NJ) integrated laser endoscope system. Patients were followed-up for a minimum of 6 months or until declared treatment failures. Treatment success is defined as a postoperative intraocular pressure of ≤ 21 mm Hg, with or without adjunctive glaucoma medications. Results: Baseline mean pretreatment intraocular pressure was 35.06 ± 8.55 mm Hg. Final postoperative intraocular pressure was 23.63 ± 11.07 mm Hg (30% decrease) after an average of 1.42 ± 0.87 endolaser procedures and 19.25 ± 19.36 months of follow-up. Success rate of the initial procedure at last follow-up was 34%. Nine eyes (25%) were retreated at least once. Cumulative success rate after all procedures at last follow-up was 43%. Mean cumulative arc of treatment was 260° ± 58° of ciliary processes. Postoperative complications included retinal detachment in 2 patients, hypotony in 1 patient, and progression of vision loss from hand motion to no light perception in 1 patient. All 4 complications occurred in aphakic patients. Conclusions: Endoscopic diode laser cyclophotocoagulation is a moderately effective procedure for the management of difficult pediatric glaucomas. Aphakic patients may have an increased risk of significant postoperative complications, such as retinal detachment. (J AAPOS 2001;5:221-9)

Endocyclophotocoagulation for management of difficult pediatric glaucomas.

Purpose To compare the outcomes of combined endoscopic cyclophotocoagulation (ECP) and phacoemulsification cataract extraction versus cataract extraction alone in eyes with medically controlled open-angle glaucoma (OAG) and visually significant cataract. Setting Clinical practices of glaucoma specialists and comprehensive ophthalmologists. Design Prospective nonrandomized matched-control study. Methods Consecutive patients with medically controlled OAG and visually significant cataracts were treated with ECP and cataract extraction (study group) or cataract extraction alone (control group). The groups were matched in age and baseline intraocular pressure (IOP). The main outcome measures were the change in IOP and number of glaucoma medications. Secondary measures included visual acuity and postoperative complications. Results In the study group (n = 80) the mean IOP decreased (baseline: 18.1 mm Hg ± 3.0 [SD]; 1 year: 16.0 ± 2.8 mm Hg; 2 years: 16.0 ± 3.3 mm Hg). The number of glaucoma medications decreased from 1.5 ± 0.8 to 0.4 ± 0.7 (1 year and 2 years). In the control group (n = 80), the mean IOP was 18.1 ± 3.0 mm Hg (baseline), 17.5 ± 3.6 mm Hg (1 year), and 17.3 ± 3.2 mm Hg (2 years). The mean number of glaucoma medications was 2.4 ± 1.0, 1.8 ± 1.2, and 2.0 ± 1.0, respectively. The difference in IOP and medication reduction between the 2 groups was statistically significant at all timepoints. Visual acuity outcomes and complication rates were similar between the 2 groups. Conclusion Combined ECP and cataract extraction resulted in lower IOP and a greater reduction in glaucoma medications than cataract extraction alone in medically controlled OAG patients with visually significant cataract. Financial Disclosures Proprietary or commercial disclosures are listed after the references.

Endoscopic cyclophotocoagulation combined with phacoemulsification versus phacoemulsification alone in medically controlled glaucoma.

Endoscopic Photocoagulation of the Ciliary Body for Treatment of Refractory Glaucomas

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Endoscopic Photocoagulation of the Ciliary Body for Treatment of Refractory Glaucomas