Endoscopic cyclophotocoagulation (ECP) in the management of uncontrolled glaucoma with prior aqueous tube shunt

A Two-Decade Bibliometric Analysis of Laser in Ophthalmology: From Past to Present

Background

Laser therapy has been proven as an effective technique for managing ophthalmological disorders. To guide future research, we conducted a bibliometric analysis of laser applications in eye diseases from 1990 to 2022, aiming to identify key themes and trends.

Methods

We retrieved 3027 publications from the Web of Science Core Collection (WoSCC). Bibliometrix was used for science mapping of the literature, while VOSviewer and CiteSpace were applied to visualize co-authorship, co-citation, co-occurrence, and bibliographic coupling networks.

Results

From a co-citation reference network, we identified 52 distinct clusters. Our analysis uncovered three main research trends. The first trend revolves around the potential evolution of corneal laser surgery techniques, shifting from the treatment of refractive errors to broader applications in biomedical optics. The second trend illustrates the advancement of laser applications in treating a range of disorders, from retinal and ocular surface diseases to glaucoma. The third trend focuses on the innovative uses of established technologies.

Conclusion

This study offers significant insights into the evolution of laser applications in ophthalmology over the past 30 years, which will undoubtedly assist scientists in directing further research in this promising field.

The effects of the first versus second glaucoma drainage implant surgery in patients with primary open-angle glaucoma

BACKGROUND

To investigate the outcome of non-valved glaucoma drainage implant surgery (GDIS) in primary open-angle glaucoma (POAG) patients divided in the first GDI group (patients who underwent the first GDIS) and the second GDI group (patients who underwent the second GDIS because of the failed first GDIS).

METHODS

Intraocular pressure (IOP), visual acuity (VA), visual field defect (VFD), medication score (MS), survival rate of GDIS, complications, and patient background was retrospectively analyzed. Two success criteria were set: Criteria (1) IOP reduction ≥ 20% and 5 < IOP ≤ 21, Criteria (2) IOP reduction ≥ 20% and 5 < IOP ≤ 14.

RESULTS

There were 136 eyes of 109 patients in the first GDI group and 32 eyes of 27 patients in the second GDI group. In the first GDI group and II, mean preoperative IOP was 26.7 ± 6.7 mmHg and 23.7 ± 3.5 mmHg, respectively (P = 0.09). No statistically significant difference in postoperative IOP reduction was found between the two groups (P = 0.39). At 5-years postoperative, the Criteria 1 (Criteria 2) survival rate in the first GDI group and the second GDI group was 60.4% (31.7%) and 61.2% (25.6%), respectively (Criteria 1: hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.30-1.35 [P = 0.24]; Criteria 2: HR: 0.81, 95% CI: 0.46-1.44, P = 0.48). No significant difference in VA, VFD change, MS, or complications was observed. Young patient age was the only significant factor for failure in the first GDI group (odds ratio: 0.95, 95% confidence interval: 0.91-1.00, P = 0.03).

CONCLUSION

The second GDIS may be as effective as the first GDIS for IOP reduction in POAG patients, however, there is a high risk of failure in young-age patients and the surgery may be ineffective in eyes requiring Criteria 2.

Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.

Outcomes of microPulse transscleral laser therapy in eyes with prior glaucoma aqueous tube shunt

PURPOSE

To evaluate the outcomes of micropulse transscleral laser therapy (MP-TLT) in patients with uncontrolled glaucoma and prior glaucoma aqueous tube shunt.

METHODS

In this single‑center, retrospective, interventional case series, eyes that underwent MP-TLT and had prior glaucoma aqueous tube shunt surgeries were included. The Cyclo Glaucoma Laser System (IRIDEX Corporation, Mountain View, CA, USA) with the MicroPulse P3 probe (version 1) was used. Post‑operative data were collected at day 1, week 1, and months 1, 3, 6, 12, 18, 24, 30 and 36.

RESULTS

A total of 84 eyes (84 patients) with mean age of 65.8 ± 15.2 years and with advanced glaucoma (baseline mean deviation -16.25 ± 6.80 dB and best-corrected visual acuity 0.82 ± 0.83 logMar) were included in the study. Baseline mean IOP was 19.95 ± 5.6 mm Hg with a mean number of medications 3.39 ± 1.02. There were statistically significant differences in IOP between baseline and all follow-up visits (p < 0.01 for all). The mean percentage of IOP reduction between baseline and different follow-up visits ranged from 23.4% to 35.5% (p < 0.01). There was a significant reduction of visual acuity (≥ 2-lines) at 1 year (30.3%) and 2 years (76.78%). There was a statistically significant reduction in the number of glaucoma medications between baseline and all follow-up visits after postoperative week 1 (p < 0.05 for all). No severe complications including persistent hypotony and related complications were observed. At the last follow-up visit, only 24 (28%) eyes out of 84 eyes remained in the study.

CONCLUSION

MP-TLT is an effective treatment for reducing IOP and decreasing the number of medications in patients with advanced glaucoma and prior glaucoma aqueous tube shunt.

The place of endoscopic laser cyclodestruction in the system of microinvasive glaucoma surgery

Glaucoma is one of the leading causes of irreversible blindness in the world. Reducing intraocular pressure is the only way to slow down the progression of glaucomatous optic neuropathy. Minimally invasive glaucoma surgery aims to provide a safer way of reduction of intraocular pressure than traditional methods, and at the same time it is capable to reduce dependence on antihypertensive therapy. Cyclodestructive high-precision method of reducing the production of aquоeus humor occupies a confident position among modern minimally invasive glaucoma surgery methods. The data obtained as a result of studying the literature confirm our idea on the endoscopic laser cyclodestruction method as a minimally invasive, safe, reliable antiglaucomatous component of the combined surgical treatment of cataract and glaucoma.

Association between endoscopic cyclophotocoagulation and vitreous prolapse in trabeculectomy: a case report

Background

To propose that possible alteration or damage to the ciliary zonules during uncomplicated endoscopic cyclophotocoagulation (ECP) can cause complications in subsequent filtration surgery.

Case presentation

We present two cases with uncomplicated primary combined phacoemulsification and ECP that underwent subsequent trabeculectomy. Both cases were complicated with vitreous prolapse during the trabeculectomy procedure. We review the anatomy of the ciliary zonules and their spatial relationship with the ciliary processes targeted during ECP and propose an association between ECP, zonular damage and complications in subsequent trabeculectomy such as vitreous prolapse.

Conclusions

Damage to ciliary zonules during ECP may not manifest until subsequent glaucoma filtration surgery. In patients who received prior ECP, we may consider taking preventative measures to avoid associated complications such as vitreous prolapse. Patients with known risk factors for weak zonules may consider choosing alternative intraocular pressure-lowering means.

Does prior endoscopic cyclophotocoagulation (ECP) affect subsequent trabeculectomy outcomes?

Purpose

To report long-term outcomes of trabeculectomy following prior endoscopic cyclophotocoagulation (ECP).

Methods

Retrospective case-controlled comparative study reporting 2-year outcomes of eyes undergoing trabeculectomy following failed prior ECP (group 1), using eyes undergoing trabeculectomy as a primary glaucoma procedure as controls (group 2).

Results

Filtration surgery was required in only 19.4% (12/62) of eyes undergoing ECP. Of these, nine eyes that underwent trabeculectomies were included in group 1. Nine matched eyes were used as controls and included in group 2. Mean baseline IOPs were 23.7 ± 7.7 and 26.0 ± 6.7 mmHg (p = 0.452) in groups 1 and 2, respectively, on a mean of 3.4 ± 0.9 and 2.8 ± 1.4 medications, respectively (p = 0.274). The mean 2-year IOP was 10.6 ± 5.2 and 12.9 ± 4.0 mmHg (p = 0.285) in groups 1 and 2, respectively, on a mean of 0.1 ± 0.3 and 0.1 ± 0.4 medications (p = 0.931) respectively. Complete success rates were 77.8% and 88.9% in groups 1 and 2, respectively (p = 0.527). Qualified success rates were 11.1% in both groups. Combined success rates were 88.9% and 100.0% in groups 1 and 2, respectively (p = 0.318). There were no failures in group 2, compared to 11.1% in group 1 (p = 0.318). There were no significant between-group differences in hypotony, bleb needling, cystoid macular oedema, persistent uveitis, or repeat filtration surgery rates.

Conclusions

ECP is a safe initial procedure in eyes with progressive glaucomas, and may substantially reduce the need for trabeculectomy without compromising outcomes in the minority that go on to require it.

An update on continuous-wave cyclophotocoagulation (CW-CPC) and micropulse transscleral laser treatment (MP-TLT) for adult and paediatric refractory glaucoma

PURPOSE

Continuous-wave cyclophotocoagulation (CW-CPC) is often preferred to medical and surgical treatments for managing refractory glaucoma. This review summarizes diode CW-CPC indications, history, histopathology, methods, efficacy and safety. It also provides an overview of the latest data available on micropulse transscleral laser treatment (MP-TLT) that uses repetitive micropulses of diode laser energy in an off-and-on cyclical fashion.

METHODS

A literature review was conducted on transscleral CW-CPC (CW-TSCPC), endoscopic CPC (ECP) and MP-TLT. Relevant series of adult and paediatric patients were included for assessing the procedures.

RESULTS

Regarding CW-TCPC, highly variable success rates are reported in the literature, depending on the definition of success, type of underlying glaucoma, energy settings, follow-up duration and retreatment rates. CW-CPC often needs to be repeated, especially in paediatric patients. CW-CPC exposes to risks of inflammation and chronic ocular hypotony or phthisis with irreversible visual loss. CW-TSCPC has mainly been used in very severe forms of glaucoma, in painful eyes with limited visual potential or after filtering surgery failure. Published data on ECP are more limited but overall good success rates have been reported. Through the direct visualization of the targeted ciliary body in anatomically abnormal eyes, ECP is the preferred surgical procedure in paediatric refractory glaucoma. Complication rates are relatively low after ECP; however, large studies with long-term follow-up are needed. ECP may be used in difficult, refractory cases, but it is often used earlier when combined with cataract surgery. Despite limited data on the exact mechanism of action of MP-TLT and a lack of standardization of laser settings, the first data from heterogeneous case series shows that it has a similar efficacy and a better safety profile compared to CW-TSCPC in the medium term.

CONCLUSION

Although they may lead to sight-threatening complications, both CW-TSCPC and ECP seem effective. ECP appears to be superior to CW-TSCPC in paediatric refractory glaucoma. Unlike ECP combined with cataract surgery, evidence supporting a wider use of CW-TSCPC and MP-TLT in earlier stages of neuropathy is lacking. While it now appears that the safety profile of MP-TLT is superior to that of CW-CPC, robust prospective comparative studies including homogeneous and well-defined cohorts of patients are still needed to confirm an at least comparable efficacy in the long term.

Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery

Minimally invasive glaucoma surgery (MIGS) has become a reliable standard of care for the treatment of glaucoma when combined with cataract surgery. This review describes the MIGS procedures currently combined with and without cataract surgery with a focus on visual outcomes based on the literature and the experience of the ASCRS Glaucoma Clinical Committee.

Differential Efficacy of Combined Phacoemulsification and Endocyclophotocoagulation in Open-angle Glaucoma Versus Angle-closure Glaucoma

PRéCIS:: This retrospective study found that combined phacoemulsification and endocyclophotocoagulation reduced intraocular pressure (IOP) to a greater degree in angle-closure glaucoma versus open-angle glaucoma and was effective for all stages of glaucoma.

PURPOSE

Endocyclophotocoagulation (ECP) laser treatment of the ciliary processes is believed to decrease IOP by reducing aqueous production. Anecdotal experience in angle-closure glaucoma suggests that it may also lower IOP by opening the drainage angle to promote aqueous outflow. This study sought to evaluate combined phacoemulsification and ECP (phaco/ECP) in eyes with different types and stages of glaucoma.

PATIENTS AND METHODS

A Retrospective chart review of eyes that underwent phaco/ECP between October 2010 and December 2016 at one institution was conducted.

RESULTS

In 63 eyes of 63 patients with an average of 3.0±1.7 years of follow-up, the 22 eyes with chronic angle-closure glaucoma (CACG) had greater IOP reduction and medication reduction than the 41 eyes with primary open-angle glaucoma at both 1 year (6.4 vs. 2.1 mm Hg, P=0.01; 0.9 vs. 0.2 medications, P=0.04) and final follow-up (6.2 vs. 2.4 mm Hg, P=0.02; 0.9 vs. 0.3 medications, P=0.05). There was no difference in IOP reduction or medication reduction for eyes with mild, moderate, or advanced glaucoma at both 1 year (3.5, 3.9, 0.5 mm Hg, respectively, P=0.18; 0.3, 0.6, 0.4 medications, P=0.58) and final follow-up (3.3, 4.8, 0.7 mm Hg, P=0.11; 0.1, 0.8, 0.4 medications, P=0.14).

CONCLUSIONS

Eyes with CACG were more responsive to phaco/ECP in terms of IOP and medication reduction compared with eyes with primary open-angle glaucoma. This finding could be partially or entirely due to concurrent cataract extraction and greater CACG preoperative IOP. Phaco/ECP was effective in all stages of glaucoma.

Combined Endoscope assisted Procedures (CEaP) as a complete treatment for neovascular glaucoma

Purpose

To investigate the effect and complications of Combined Endoscope assisted Procedures (CEaP): endoscopic cyclophotocoagulation and pars plana ablation (ECP-plus), along with endoscopic panretinal photocoagulation (PRP).

Patients and methods

The study design is a retrospective and noncomparative interventional case series from a tertiary referral center in Taiwan. Patients experiencing vessel growth at the iris and anterior chamber angle, along with an IOP > 21 mmHg were included.

Results

Twenty-five eyes from 23 patients were included over a 24-month period. After the procedures, all of them had a lower IOP value than their preoperative value. The mean IOP was 38.2± 7.1 mm Hg preoperatively, and 10.2± 4.7 mmHg (1 day), 13.8± 4.6 mmHg (1 week), 15.0± 5.3 mmHg (2 weeks), 17.4± 4.7 mmHg (1 month), 16.6± 4.1 mmHg (3 months), 16.0± 5.0 mmHg (6 months), and 15.7± 5.5 mmHg (12 months) postoperatively. At the 6th and 12th months, the IOP stabilized rate was 84% and 75%, respectively. Complications in the initial postoperative period (< 3 months) included uveitis (24%), and hyphema (16%), which were both resolved in the early postoperative period. Complications beyond 6 months included hypotony and phthisis bulbi in two patients (8%) in our study. There was no subject who suffered from retinal detachment, endophthalmitis or any other severe complications.

Conclusions

The results of this study show that CEaP offers positive results in IOP lowering and NV regression. Additionally, CEaP is a complete treatment for NVG in controlling IOP and NV growth. The IOP lowering effects can be sustained upon completion of the treatment.

Transscleral versus endoscopic cyclophotocoagulation outcomes for refractory glaucoma

OBJECTIVES

Evaluate the efficacy of transscleral cyclophotocoagulation versus endoscopic cyclophotocoagulation to reduce intraocular pressure.

METHODS

A retrospective, non-randomized cohort study with 1 year of follow-up included 62 eyes of 62 refractory glaucoma patients who underwent transscleral cyclophotocoagulation or endoscopic cyclophotocoagulation.

RESULTS

Thirty-two patients were enrolled in transscleral cyclophotocoagulation group and 30 patients in endoscopic cyclophotocoagulation group, and the follow-up period was 1 year. The mean preoperative intraocular pressure was 35.6 ± 12.9 mm Hg in the transscleral cyclophotocoagulation group and 31.8 ± 8.8 mm Hg in the endoscopic cyclophotocoagulation group without significant difference (p = 0.18). When we compare both groups, there was no difference at 1 month (p = 0.46) and 3 months (p = 0.21) after surgery. However, there was a statistically significant difference at month 6 (p = 0.0055) and 1 year (p = 0.0019), finding lower intraocular pressure in the transscleral cyclophotocoagulation group. Cumulative success for intraocular pressure <21 mm Hg was 93.8% in transscleral cyclophotocoagulation group and 83.3% in endoscopic cyclophotocoagulation group after 1 year (p = 0.2). For intraocular pressure <18 mm Hg, the success rate was 78.1% in transscleral cyclophotocoagulation group and 63.3% in endoscopic cyclophotocoagulation group (p = 0.06), and for intraocular pressure <16 mm Hg, the success rate was 62.5% in transscleral cyclophotocoagulation group and 43.3% in endoscopic cyclophotocoagulation group (p = 0.02). Hypotony (p = 0.01) and vision loss of two lines (p = 0.01) were statistically significant lower in endoscopic cyclophotocoagulation group.

CONCLUSION

This study demonstrates that both transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation are effective at decreasing intraocular pressure. However, transscleral cyclophotocoagulation is related to more complications than endoscopic cyclophotocoagulation, whereas endoscopic cyclophotocoagulation shows lower intraocular pressure decrease than transscleral cyclophotocoagulation.

Prospective Studies of Minimally Invasive Glaucoma Surgeries: Systematic Review and Quality Assessment

Glaucoma is a common blinding disease; while there is no cure, effective treatments include medications, laser, and incisional surgery. There is significant interest from patients and doctors to develop safer surgical options throughout the spectrum of disease, to minimize treatment burden in mild glaucoma patients and to minimize risk of complications in patients needing more aggressive treatment. Surgical procedures called Minimally or Micro-Invasive Glaucoma Surgery (MIGS) are growing in popularity. Eighty-seven prospective studies on MIGS were identified and assessed for quality. Most (74%) did not have a control group. Twelve of the highest quality were reviewed. MIGS procedures appeared to have fewer complications, and lowered intraocular pressure, and reduced medication use. Studies were limited by small sample size, narrow spectrum of glaucomatous disease, and/or conflicts of interest. There is a need for high quality, independently funded and performed, comparative studies on the MIGS to help make treatment decisions.

Trabeculectomy Outcomes After Glaucoma Drainage Device Surgery

PURPOSE

To evaluate outcomes of trabeculectomy with adjunctive mitomycin C in patients with uncontrolled intraocular pressure (IOP) after glaucoma drainage device implantation.

MATERIALS AND METHODS

Consecutive patients who had undergone a trabeculectomy after GDD were reviewed. The primary outcome was surgical success with stratified IOP targets based on the following criteria: (A) IOP<18 mm Hg and IOP reduction of 20%; (B) IOP<15 mm Hg and IOP reduction of 25%; (C) IOP<12 mm Hg and IOP reduction of 30%. Secondary outcomes were number of glaucoma medications, complications, and need for additional glaucoma surgery.

RESULTS

Twenty eyes (19 patients) were included for analysis. Median follow-up and age were 3.7 years (range, 1.1 to 10.2 y) and 64.2 years (range, 25.2 to 85.6 y), respectively. Mean IOP (±SD) has dropped from 19.3±4.2 mm Hg preoperatively to 9.8±2.2 mm Hg at 1 year, 8.8±3.2 mm Hg at 3 years and 8.4±1.5 mm Hg at 5 years (P<0.001 for all). Hypotony maculopathy was the only serious complication (2/19 patients; 10%) that needed surgical revision. The cumulative success rate (±SD) for criterion A and B were 73.2% (±10.0%) and 68.2% (±9.5%), respectively, between the first and fifth year of follow-up, for criterion C it was 49.1% (±10.8%) at the first year and 32.7% (±12%) between the second and fifth year of follow-up.

CONCLUSIONS

Trabeculectomy is a viable surgical option to treat IOP that is uncontrolled after GDD implantation.

A case series of endoscopic cyclophotocoagulation with 532-nm laser in Japanese patients with refractory glaucoma

PURPOSE

To report an initial case series of Japanese patients with refractory glaucoma treated with endoscopic cyclophotocoagulation (ECP) using an ECP device that was equipped with a 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser.

METHODS

This observational case series included 10 consecutive glaucomatous eyes (7 with primary open-angle glaucoma; 3 with secondary glaucoma after cataract surgery) of 10 Japanese subjects (7 men, 3 women; mean age ± standard deviation, 65.7 ± 15.0 years) who underwent ECP to control intraocular pressure (IOP), and preserve visual function. Age, sex, glaucoma type, ocular surgical history, preoperative and postoperative logarithm of the minimum angle of resolution visual acuity (VA), IOP, number of antiglaucoma medications, perioperative complications, and treatments for complications were collected from the medical and surgical records. The IOP and numbers of antiglaucoma medications were compared between preoperative and postoperative values.

RESULTS

The mean preoperative IOP (27.3 ± 5.4 mm Hg; range, 19-36) and number of antiglaucoma medications (4.4 ± 0.8; range, 3-6) decreased significantly by 53% and 39% ( p = 0.0005 and p = 0.0043, respectively) to 12.9 ± 5.2 mm Hg (range, 8-20) and 2.7 ± 1.4 (range, 0-4), respectively, at the final visit. Compared with preoperative values, a mixed-effect regression model showed significant decreases in the IOP and numbers of medications at every time point up to 24 months postoperatively. No phthisis bulbi or persistent hypotony was recorded. At the final visit, compared with preoperative values, the VA decreased in three eyes by >0.2 unit because of glaucoma progression.

CONCLUSIONS

ECP with Nd:YAG laser is a reasonable option in eyes with refractory glaucoma.

Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope: A modified technique of ciliary body photocoagulation

Purpose:

This study aimed to investigate the efficacy of cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope in treating refractory glaucoma.

Methods:

Eleven patients (11 eyes) with refractory neovascular glaucoma were treated with ciliary body photocoagulation. Preoperative and postoperative corrected visual acuity, intraocular pressure (IOP), ophthalmofundoscopy, B-ultrasound and ultrasound biomicroscopy, optical coherence tomography, and fundus fluorescein angiography were performed.

Results:

Preoperative IOP ranged from 45 to 58 mmHg (mean 51.9 mmHg). At postoperative 1, 3, and 6 months, the IOPs ranged between 16 and 33 mmHg (mean 27.1 mmHg), 14–28 mmHg (mean 20.6 mmHg), and 14–28 mmHg (mean 18.5 mmHg), respectively. IOP at the last follow-up (range 7–12 months) was 15–24 mmHg (mean 18.8 mmHg). An average of 63.8% decrease in postoperative IOP was found in these patients with no associated complications. The postoperative fibrotic exudate, anterior chamber hyphema, and exudative choroidal detachment were all well-managed and resolved. No patients experienced intraocular lens deviation or dislocation, hypotonia oculi, atrophy of eyeball, retinal detachment, endophthalmitis, or sympathetic ophthalmia.

Conclusion:

Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope is a safe and effective technique for the treatment of neovascular glaucoma.

Endoscopic cyclophotocoagulation (ECP) for open angle glaucoma and primary angle closure

BACKGROUND

Glaucoma is a leading cause of irreversible blindness. A number of minimally invasive surgical techniques have been introduced as a treatment to prevent glaucoma progressing. Among them, endoscopic cyclophotocoagulation (ECP) is a cyclodestructive procedure developed by Martin Uram in 1992.

OBJECTIVES

To evaluate the efficacy and safety of ECP in people with open angle glaucoma (OAG) and primary angle closure whose condition is inadequately controlled with drops.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 12 July 2018.

SELECTION CRITERIA

We searched for randomised controlled trials (RCTs) of ECP compared to other surgical treatments (other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. We also planned to include trials where these devices were combined with phacoemulsification compared to phacoemulsification alone.

DATA COLLECTION AND ANALYSIS

Two review authors planned to independently extract data from reports of included studies using a data collection form and analyse data based on methods expected by Cochrane. Our primary outcome was proportion of participants who were drop-free (not using eye drops). Secondary outcomes included mean change in IOP; proportion of participants who achieved an IOP of 21 mmHg or less, 17 mmHg or less or 14 mmHg or less; and proportion of participants experiencing intra- and postoperative complications, We planned to measure all outcomes in the short-term (six to 18 months), medium-term (18 to 36 months), and long-term (36 months onwards).

MAIN RESULTS

We found one ongoing study that met our inclusion criteria (ChiCTR-TRC-14004233). The study compares combined phacoemulsification with ECP to phacoemulsification alone in people with primary angle closure glaucoma. The primary outcome is intraocular pressure (IOP) and number of IOP-lowering drugs. A total of 50 people have been enrolled. The study started in February 2014 and the trialists have completed recruitment and are in the process of collecting data.

AUTHORS' CONCLUSIONS

There is currently no high-quality evidence for the effects of ECP for OAG and primary angle closure. Properly designed RCTs are needed to assess the medium and long-term efficacy and safety of this technique.

Endoscopic Cyclophotocoagulation and Other Cyclodestructive Methods: Histopathologic Comparison of In Vivo Treatment in Humans and Monkeys

PURPOSE

To compare the histologic effects of endoscopic cyclophotocoagulation (ECP) with other ciliary body ablative procedures. A secondary aim was to correlate these findings with historical clinical success and complication rates.

DESIGN

Prospective, qualitative comparison of histopathologic tissue analysis.

PARTICIPANTS

Two eyes of two patients who had undergone ECP for open-angle glaucoma were studied. Two eyes from a healthy monkey were treated with ECP and studied. For comparison, 1 eye each of patients who had undergone contact and noncontact neodymium:yttrium-aluminum-garnet transscleral cyclophotocoagulation (TCP) for open-angle glaucoma were analyzed.

METHODS

The human globes were enucleated and submitted for analysis by gross examination and light and electron microscopy. Monkey eyes were studied by gross examination and light microscopy 1 week, 2 weeks, and 1 month after ECP.

MAIN OUTCOME MEASURES

Gross and histopathologic specimens of all eyes were analyzed with respect to location and type of tissue effects and degree of collateral damage.

RESULTS

The gross analysis of all ECP specimens showed a uniform anterior-to-posterior whitening of each treated ciliary process. This correlated with microscopic evidence of loss of pigmentation from the pigmented ciliary epithelial cells seen with mostly preserved architecture and vasculature of the ciliary processes. By comparison, the TCP specimens showed erratic treatment of the ciliary processes with overlap into the pars plicata of the ciliary body. Microscopic analysis revealed significant disruption of the cells throughout the ciliary processes and loss of vessels within the stroma.

CONCLUSIONS

Treatment with ECP results in less overall tissue destruction and a targeted effect on the pigmented ciliary epithelium of the ciliary processes when compared with TCP.

Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options

The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.

Long-term Outcome of Second Ahmed Valves in Adult Glaucoma

PURPOSE

To evaluate the long-term outcomes of second Ahmed glaucoma valve (AGV) implants in eyes with glaucoma.

DESIGN

Retrospective interventional case series.

METHODS

Patients with sequential second Ahmed valves implanted in the same eye from 1994 to 2016 were included. Success was defined with 3 criteria: (1) intraocular pressure (IOP) ≤ 21 mm Hg and IOP reduction of 20%; (2) IOP ≤ 18 mm Hg and IOP reduction of 25%; and (3) IOP ≤15 mm Hg and IOP reduction of 30%. The primary analysis was the 5-year Kaplan-Meier survival rate for each criterion. Failure was established when the success criterion was not met at 2 consecutive visits at least 3 months after the surgery. Loss of light perception, requirement for additional glaucoma surgery, hypotony maculopathy, and serious complications were also considered failures.

RESULTS

One hundred ten eyes from 104 patients were included with a mean follow-up of 5.0 years (interquartile range [IQR] 1.6-7.33 years). The median (IQR) age at the second AGV was 68.0 (53.5-77.9) years. The median (IQR) time between surgeries was 2.1 (0.7-4.0) years. The 5-year Kaplan-Meier survival rates were 57%, 51%, and 30% for criteria 1, 2, and 3, respectively.

CONCLUSION

A second AGV is effective in reducing IOP in patients who require additional IOP lowering after a first AGV. The success rates are comparable to primary AGV implantation, and to trabeculectomy in eyes with a previously implanted glaucoma drainage device. A second AGV is a viable option in eyes with inadequate IOP levels after a primary AGV.

Comparison of Outcomes between Endoscopic and Transcleral Cyclophotocoagulation

Importance: Traditionally cyclophotocoagulation has been reserved as a treatment of last resort for eyes with advanced stage glaucoma, but increasingly it is offered to eyes with less severe disease. Endoscopic approaches in particular are utilized in increasing numbers of patients despite only a small number of publications on its results. Objective: The purpose of this study was to compare the efficacy and safety of endoscopic and transcleral cyclophotocoagulation (ECP and TCP) procedures in eyes with refractory glaucomas. Design, Setting, and Participants: A chart review was performed on consecutive patients who underwent ECP and TCP at a tertiary ophthalmology care center between January 2000 and December 2010. Cases with fewer than 3 months of follow-up or that had concurrent pressure reducing procedures were excluded. The main outcome measures examined were intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), additional glaucoma procedure required, and complications. Main Outcomes and Measures: Forty-two eyes (42 patients) that underwent ECP and forty-four eyes (44 patients) that underwent TCP were identified. The TCP group had a statistically higher mean age (71.2 ± 16.7 vs. 58.1 ± 22.9 years, respectively), larger proportion of neovascular glaucoma (40.9% vs. 16.7%), worse initial BCVA (logMAR 2.86 vs. 1.81), and higher preoperative IOP (45.3 vs. 26.6 mmHg) than the ECP group. At 12 months follow-up, the mean IOP difference between groups was not statistically significant, although the change in IOP from baseline to 12 months was greater for the TCP group (p = 0.006). The rates of progression to no light perception (NLP) and phthisis bulbi were significantly higher amongst TCP eyes than ECP eyes (27.2% vs. 4.8%, p = 0.017, and 20.5% vs. 0%, p = 0.003, respectively). Of these eyes that progressed, a majority had neovascular glaucoma (NVG). Corneal decompensation was the most frequent complication following ECP (11.9%). Conclusions and Relevance: In patients with preoperative BCVA of 20/400 or better, overall complication rates (cystoid macular edema, exudative retinal detachment, inflammation, cornea decompensation) were higher after ECP than with TCP. In refractory glaucomas in a real world setting (not a trial), TCP was more frequently used in ischemic eyes. TCP was associated with a higher rate of progression to phthisis bulbi and loss of light perception than ECP. However, ECP was associated with a clinically significant rate of corneal decompensation. These outcomes likely were related to the severity of underlying ocular diseases found in these eyes.

Microinvasive Glaucoma Surgery: An Evidence-Based Assessment

Introduction

The advent of Microinvasive Glaucoma Surgery (MIGS) offers a novel approach in the treatment of glaucoma with the number of procedures developing at an exciting pace.

Areas Covered

MIGS procedures aim to lower intraocular pressure (IOP) via four mechanisms: (1) increasing trabecular outflow, (2) increasing outflow via suprachoroidal shunts, (3) reducing aqueous production, and (4) subconjunctival filtration. A comprehensive search for published studies for each Microinvasive Glaucoma Surgery (MIGS) device or procedure was undertaken using the electronic database PubMed. Search terms included 'minimally invasive glaucoma surgery', 'microincisional glaucoma surgery', and 'microinvasive glaucoma surgery'. A manual search for each device or procedure was also performed. After review, randomized control trials and prospective studies were preferentially included.

Expert Opinion

These procedures offer several benefits: an improved safety profile allowing for intervention in earlier stages of glaucoma, combination with cataract surgery, and decreased dependence on patient compliance with topical agents. Established MIGS procedures have proven efficacy and more recent devices and procedures show promising results. Despite this, further study is needed to assess the long term IOP-lowering effectiveness of these procedures. Particularly, rigorous study with more randomized control trials and head-to-head comparisons would allow for better informed clinical and surgical decision-making. MIGS offers new solutions for glaucoma treatment.

High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction?

The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC³), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC³ shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC³ was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC³, summarizing the current knowledge about this procedure and future possible developments.

Intermediate-term and long-term outcome of piggyback drainage: connecting glaucoma drainage device to a device in-situ for improved intraocular pressure control

IMPORTANCE

This study provides results of a treatment option for patients with failed primary glaucoma drainage device.

BACKGROUND

The study aimed to describe and evaluate the long-term intraocular pressure control and complications of a new technique joining a second glaucoma drainage device directly to an existing glaucoma drainage device termed 'piggyback drainage'.

DESIGN

This is a retrospective, interventional cohort study.

PARTICIPANTS

Eighteen eyes of 17 patients who underwent piggyback drainage between 2004 and 2013 inclusive have been studied. All patients had prior glaucoma drainage device with uncontrolled intraocular pressure.

METHODS

The piggyback technique involved suturing a Baerveldt (250 or 350 mm) or Molteno3 glaucoma drainage device to an unused scleral quadrant and connecting the silicone tube to the primary plate bleb.

MAIN OUTCOME MEASURES

Failure of intraocular pressure control defined as an intraocular pressure greater than 21 mmHg on maximal therapy on two separate occasions or further intervention to control intraocular pressure.

RESULTS

The intraocular pressure was controlled in seven eyes (39%) at last follow-up with a mean follow-up time of 74.2 months. The mean preoperative intraocular pressure was 27.1 mmHg (95% confidence interval 23.8-30.3) compared with 18.4 mmHg (95% confidence interval 13.9-22.8) at last follow-up. The mean time to failure was 57.1 months (95% confidence interval 32.2-82), and the mean time to further surgery was 72.3 months (95% confidence interval 49.9-94.7). Lower preoperative intraocular pressure was associated with longer duration of intraocular pressure control (P = 0.048). If the intraocular pressure was controlled over 2 years, it continued to be controlled over the long term. Two eyes (11%) experienced corneal decompensation.

CONCLUSIONS

Piggyback drainage represents a viable surgical alternative for the treatment of patients with severe glaucoma with failing primary glaucoma drainage device, particularly in those at high risk of corneal decompensation.

Refractive outcome of combined phacoemulsification and endoscopic cyclophotocoagulation

PURPOSE

To compare the refractive outcome of eyes that underwent phacoemulsification combined with endoscopic cyclophotocoagulation (phaco-ECP) with the eyes that underwent phacoemulsification alone.

METHODS

A retrospective case series review of 103 consecutive eyes that underwent phaco-ECP and 62 eyes that underwent phacoemulsification between January 2006 and August 2012 was conducted. Post-operative refractive outcomes were obtained by subjective refraction or autorefraction. Demographic data, best corrected visual acuity, intraocular pressure, number of glaucoma agents and mean deviation of the Humphrey visual field test (MD) were also analysed.

RESULTS

The total number of eyes included in the study was 62 eyes for the phaco-ECP group and 62 eyes for the control group who underwent phacoemulsification alone. More than 90% of eyes (n = 56) in phaco-ECP group achieved post-operative refraction within ±1 dioptre (D) of the target refraction. In the control group, 100% of eyes achieved post-operative refraction within ±1D of the target refraction. When comparing the difference between the target and the actual refractive outcome between the phaco-ECP and the control group, there was no statistically significant difference.

CONCLUSIONS

Refractive outcome after phaco-ECP is comparable to phacoemulsification alone. This study suggests that the intraocular lens power can be selected for cataract surgery alone and that ECP does not change the effective lens position significantly; therefore, no modification of biometry formulae is required. Phaco-ECP should be considered as an effective, safe and predictable surgical treatment option for glaucoma patients with co-existing cataract.

Outcomes of Sequential Glaucoma Drainage Implants in Refractory Glaucoma

PURPOSE

To describe the outcomes of eyes that have undergone a second glaucoma drainage implant (GDI) surgery.

METHODS

A retrospective review of eyes that underwent a second GDI surgery from 2006 to 2013 was conducted. Primary outcome measures included intraocular pressure (IOP) reduction and success rates. Secondary outcome measures included glaucoma medication use, visual acuity, and number of reoperations. Success was defined as 6 ≤ IOP ≤ 21 with at least 20% IOP reduction, and no increase in the number of glaucoma medications from baseline at 3 months of follow-up or more.

RESULTS

Sixty-five eyes (63 patients) had a mean follow-up of 22.4 ± 19.9 months. The most frequently placed second GDIs were an Ahmed FP7 (49%) or a Baerveldt 250 (26%) in the inferotemporal (46%) or inferonasal (35%) quadrant. At 3-year follow-up, IOP was reduced from 25.8 ± 7.7 to 17.4 ± 9.9 mm Hg (P = 0.004) and the number of glaucoma medications decreased from 3.6 ± 1.2 to 2.5 ± 1.4 (P = 0.01) compared with baseline. The median time to failure was 24.7 ± 5.8 months. There was no significant difference in failure rates for type of sequential GDI (P = 0.80) or plate location (P = 0.34). There was no significant difference in visual acuity between baseline and 3-year follow-up (P = 1.0). The most common postoperative complication was corneal edema (n = 9, 14%).

CONCLUSIONS

Most eyes undergoing a second GDI achieve adequate IOP control with fewer antiglaucoma medications. Failure rates were similar regardless of quadrant selection or GDI type.

Endoscopic Cyclophotocoagulation and Pars Plana Ablation (ECP-plus) to Treat Refractory Glaucoma

PURPOSE

To report clinical outcomes after pars plana endoscopic cyclophotocoagulation of the ciliary processes and pars plana (ECP-plus), a novel treatment for refractory glaucoma.

DESIGN

Retrospective, noncomparative interventional case series.

MATERIALS AND METHODS

SETTING

multicenter tertiary referral academic and clinical practice.

STUDY POPULATION

fifty-three eyes of 53 consecutive subjects undergoing ECP-plus who had uncontrolled intraocular pressure (IOP) despite prior glaucoma surgeries and maximally tolerated medical therapy.

OBSERVATION PROCEDURE

retrospective analysis of clinical data after ECP-plus and pars plana vitrectomy.

MAIN OUTCOME MEASURES

primary outcome was IOP at 6 and 12 months. Secondary outcomes were number of glaucoma medications and postoperative complications.

RESULTS

Diagnoses were primary open-angle glaucoma (32%), chronic angle-closure glaucoma (26%), and secondary open-angle glaucoma (OAG, 42%); 50/53 of subjects had 6 months' and 28/53 had 12 months' follow-up data. Preoperative IOP was 27.9±7.5 mm Hg (mean±SD). Postoperative IOP at 6 mo was 10.2±5.6 and at 12 mo was 10.7±5.2 lower than preoperative levels (all P<0.0001). Cumulative treatment success was 81% at 6 mo and 78% at 12 mo. Number of medications fell from 3.4±1.2 pretreatment to 0.8±1.0 at 1 to 6 mo and 0.7±1.2 at 12 mo postoperatively (all P<0.0001). Complications in the initial postoperative period (<3 mo) were hypotony (3/53, 6%), fibrinous uveitis (2/53, 4%), and cystoid macular edema without hypotony (CME; 4/53, 6%). Complications beyond 6 mo occurred in 8/50 (16%) subjects as hypotony (4/50, 8%), choroidal detachment (4/50, 3 with IOP<5 and 1 with IOP≥5; 8%), CME without hypotony (3/50, 6%), and failed corneal graft (1/50, 2%).

CONCLUSIONS

The mean IOP was lowered by at least 61% after ECP-plus and IOP lowering was sustained over the follow-up period. Fewer glaucoma medications were needed. Complication rates were comparable with or slightly higher than anterior endoscopic cyclophotocoagulation and acceptable given the refractory nature of disease being treated.

Current and Future of Laser Therapy in the Management of Glaucoma

There has been tremendous progress in the past decades in the utilization of lasers for treating patients with glaucoma. This article reviews the use of lasers in different areas of glaucoma, including the shift from argon laser trabeculoplasty (ALT) to selective laser trabeculoplasty (SLT), laser trabeculoplasty as an initial treatment for glaucoma, new laser trabeculoplasty procedures under investigation, and other recent laser treatment modalities such as endoscopic cyclophotocoagulation and laser-assisted deep sclerectomy.

Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush

Objective: To assess the utility of viscoelastic injection to induce bleb expansion and decrease intraocular pressure (IOP) in eyes with encapsulated glaucoma tube shunt blebs.

Design: Case series.

Subjects and participants: Forty-three glaucomatous eyes, including 13 eyes with congenital, 13 uveitic, 5 neovascular, 5 open angle, 4 narrow angle and 3 traumatic glaucomas.

Methods, interventions or testing: All patients underwent viscoelastic flush procedure. A pre-bent 27 or 30-gauge cannula was passed through a 25-gauge paracentesis, advanced over the iris across the anterior chamber, and insinuated into the tube shunt lumen. Once the cannula was firmly lodged in position, 0.45 to 0.85 ml of viscoelastic was injected to hyperinflate the bleb.

Main outcome measures: Paired t-tests were performed comparing preoperative IOP and number of medications used preoperatively vs levels measured at 1, 6, 12, 18 and 24 months.

Results: Intraocular pressure was reduced from a mean preoperative level of 26.0 ± 1.2 (sem) mm Hg to 15.8 ± 1.0 at 1 month, remaining stable thereafter at each 6-month interval with 15.1 ± 1.1 mm Hg at 24 months (p < 0.0001). Medication use did not vary significantly from baseline. Pressure remained < 21 mm Hg after 2 years in 85% of eyes cannulated within 1 year of primary tube shunt implantation (n = 23), and in 62% of eyes cannulated more than 1 year after tube shunt placement (n = 20).

Conclusion: Tube shunt expansion with bolus viscoelastic flush successfully restored encapsulated bleb function, providing a substantial (~10 mm Hg) IOP decrease into the mid-normal pressure range. This persisted in the majority of treated eyes for the entire study period.

How to cite this article: Groth SL, Greider KL, Sponsel WE. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. J Curr Glaucoma Pract 2015;9(3):73-76.

The use of endoscopic cyclophotocoagulation for moderate to advanced glaucoma

Endoscopic Cyclophotocoagulation (ECP) is a glaucoma surgery designed to reduce the intraocular pressure (IOP) by partially ablating the ciliary processes to decrease aqueous humour production and secretion. The aim of this paper is to review the literature regarding the background, indications and results of the surgery. Although there are case reports of visually devastating complications, including persistent hypotony and phthisis, the use of ECP is often reported in eyes with advanced diseases. When compared with both trabeculectomy and aqueous shunt implantation, the visual outcomes were better with ECP while the IOP outcomes were very similar. The evidence supports ECP as a very effective surgical option in recalcitrant glaucoma while some evidence supports its safety for use as a primary procedure.

Endoscopic cyclophotocoagulation

In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.

Intracameral injection of tissue plasminogen activator to treat severe postoperative fibrinous reaction in iridocorneal endothelial syndrome

Iridocorneal endothelial (ICE) syndrome is a primary endothelial abnormality that can cause a spectrum of iris changes, corneal edema, and glaucoma. Glaucoma secondary to ICE is difficult to manage because of the inflammatory reaction and fibrosis it can cause. We present a case of postoperative fibrinous reaction following endoscopic cyclophotocoagulation in ICE that caused aqueous tube shunt occlusion and high intraocular pressure. The condition was successfully managed with tissue plasminogen activator.

Endoscopic ophthalmic surgery of the anterior segment

We summarize the uses of anterior segment endoscopic techniques and the basic science and technology of endoscopic cyclophotocoagulation (ECP) as compared with transscleral cyclophotocoagulation. This is followed by an analysis of patient selection for ECP, a description of surgical techniques, and clinical results. In addition, the ophthalmic endoscope has other uses in anterior segment surgeries. We discuss the techniques for these endoscope-assisted surgeries.

Update on results and complications of cyclophotocoagulation

PURPOSE OF REVIEW

This review highlights recently published studies on transscleral and endoscopic diode cyclophotocoagulation (TCP, ECP) and summarizes the treatment results and complications.

RECENT FINDINGS

Although both TCP and ECP are efficacious procedures for the treatment of refractory glaucoma, no consensus exists for optimum treatment protocol. TCP has mainly been used as a last-resort treatment for intractable glaucoma with very limited visual potential. Repeated treatment is often required. Serious complications include vision loss, hypotony, and phthisis. High treatment energy per session and underlying abnormality seem risk factors for these complications. Recent growing numbers of investigations are giving promising results for TCP as a primary surgery in eyes with good vision. Although ECP came later into clinical use for glaucoma treatment, it is becoming more accepted and no longer reserved for end-stage cases. ECP is most commonly performed in conjunction with cataract surgery and shows overall good success with relatively low complication rates. Serious complications include hypotony, phthisis, cystoid macular edema, and retinal detachment.

SUMMARY

Recent literatures suggest that both TCP and ECP are performed increasingly as the primary surgery for various types and stages of glaucoma. Both treatments are effective procedures, although potential for serious complications exists.

Previous cyclodestruction is a risk factor for late-onset hypotony and suprachoroidal haemorrhage after glaucoma drainage device surgery

AIM

To investigate whether previous cyclodestructive (eg, cyclophotocoagulation and cyclocryodestruction) procedures have any influence on the general outcome and pressure level after glaucoma drainage device (GDD) surgery.

METHODS

Retrospective analysis of 110 consecutive patients who had undergone GDD (Baerveldt 250 mm(2) and 350 mm(2) implant, AMO, USA) surgery with a minimum follow-up of 3 months. The patients were divided into patients with previous cyclodestructive surgery before GDD surgery (I; 47 patients) and patients without previous cyclodestructive surgery (II; 63 patients). Intraocular pressure (IOP), medication score, best-corrected visual acuity and surgical treatments were recorded before and after drainage device implantation.

RESULTS

Patients of group I had a mean preoperative IOP of 32.1 mm Hg and a mean medication score of 4.8; patients of group II had a mean preoperative IOP of 29.2 mm Hg (p=0.18) and a mean medication score of 4.9 (p=0.84). All patients who developed suprachoroidal haemorrhage (six cases) belonged to group I (6/47=12.8%), no patient of group II (0/63=0%) developed suprachoroidal haemorrhage (Fisher's test: p=0.01). Twelve patients developed late-onset (>6 weeks after GDD surgery) hypotony, nine of them belonging to group I (9/47=19.1%) and three of them to group II (3/63=4.8%) (Fisher's test: p=0.03).

CONCLUSIONS

While taking potential bias arising from the retrospective nature of the study into consideration, a history of previous cyclodestructive procedures before GDD surgery seems to be a major risk factor for suprachoroidal haemorrhage and for late-onset postoperative hypotony.

One Year of Glaucoma Research in Review: 2011 to 2012

PURPOSE

To provide the practicing clinical ophthalmologist with an update of pertinent glaucoma literature published over the past 12 months.

METHODS

The authors conducted a one year (July 1, 2011 to June 30, 2012) English language glaucoma literature search on Pubmed using the following terms: automated perimetry, optic nerve imaging, optical coherence tomography, glaucoma structure and function, intraocular pressure, central corneal thickness, medical therapy and compliance in glaucoma, glaucoma laser treatment, cataract extraction and intraocular pressure, secondary glaucoma, glaucoma surgery, pediatric glaucoma, molecular biology in glaucoma, and miscellaneous topics in glaucoma.

DESIGN

Literature review.

RESULTS

This review includes original and review articles that reflect novel aspects and updates in the field of glaucoma, while excluding letters to the editor, unpublished works, and abstracts.

CONCLUSIONS

This review is not meant to be all-inclusive-rather, it highlights literature that is most applicable to ophthalmologists in practice.