Endocyclophotocoagulation Research Articles

Phacoemulsification with Either Endocyclophotocoagulation or Ab-Interno Canaloplasty with or without Trabeculotomy in Uveitic Glaucoma

ABSTRACT Purpose Understanding the current role and efficacy of endocyclophotocoagulation (ECP) compared to ab-interno canaloplasty with or without trabeculotomy (OMNI), combined with cataract extraction and lens implantation (CEIOL), for the management of uveitic glaucoma (UG) is limited. Methods All UG patients ≥18 years old with ≥6 months of follow-up data (15.2 ± 5.9 months) after CEIOL combined with either ECP or OMNI from August 2019 to May 2022 at a single academic center were retrospectively reviewed [22 eyes of 15 patients (8 ECP, 14 OMNI)]. Surgical success was considered intraocular pressure (IOP) ≤21 mmHg and a reduction of baseline by ≥20% for two consecutive final visits without hypotony, additional surgery, or loss of light perception. Uveitic control was considered a <2-step increase in anterior chamber (AC) cell grade, <3+ AC cell grade, and no increase in steroid drop use at 3 months postoperatively. Secondary outcome measurements included postoperative change in IOP, glaucoma medications, best corrected visual acuity (VA), AC cell grade, and steroid drop frequency. Results Baseline ocular and preoperative characteristics of eyes (age, sex, laterality, uveitic location, systemic immunomodulating therapy, visual acuity, IOP, number of glaucoma medications, AC cell grade, and steroid drop frequency) did not significantly differ except for greater racial diversity in the ECP group. 62.5% eyes were surgically successful in the ECP group and 85.71% in the OMNI. Between-group analysis showed greater IOP reduction in the OMNI group (p < .05), but no difference in reduction of glaucoma medications (p = .33). No eyes displayed a two-step increase in or >3+ AC cell grade, however, 50% and 64.29%, respectively, increased steroid drop use. Between groups, no difference in the change of AC cell grade (p = .98) or steroid drop use (p = .84) was seen. Conclusions Both interventions improved visual acuity, IOP, and glaucoma medication use, however, OMNI was more successful at reducing IOP long term. An increase in steroid drop frequency may be the cost of a prolonged post-surgical inflammatory course related to underlying uveitis regardless of surgical approach.

Outcomes of iStent versus endocyclophotocoagulation (ECP) as adjunct to cataract surgery by phacoemulsification for glaucoma patients

Purpose To compare the efficacy and safety of iStent versus Endocyclophotocoagulation (ECP) as an adjunct to cataract surgery by Phacoemulsification for treating glaucoma patients in a tertiary eye center. Methods Retrospective study of 67 eyes of 61 patients with glaucoma and cataract who underwent either phaco-ECP or phaco-iStent. Primary efficacy endpoint is the Intraocular pressure (IOP) reduction, while reduction of glaucoma medications is the secondary outcome. In addition to IOP and number of glaucoma medications; visual acuity, degree of disc cupping, safety profiles were all assessed at different intervals up to 12 months. Results A total of 40 eyes underwent phaco-ECP, and 27 eyes underwent phaco-iStent. Both groups were associated with a significant reduction in the number of glaucoma medications; however phaco-iStent group achieved slightly lower IOP levels than the phaco-ECP group. Furthermore, iStent inject had better control of IOP at the last follow-up compared to first-generation stents. Moreover; 2 or more stents significantly reduced IOP than single stent ( p = 0.009 vs. p = 0.618, respectively). Phaco-iStent achieved a better reduction in the number of glaucoma medications for primary open-angle glaucoma ( p = 0.007) compared to pseudoexfoliation glaucoma patients ( p = 0.084). Complications were seen in 12 eyes (18%), of which five eyes in phaco-ECP (7.4%) and 7 eyes in phaco-iStent (10.4%), majority were mild and treated conservatively. Conclusions Both groups had equal efficacy in reducing the IOP. However, phaco-iStent seems superior in reducing the number of glaucoma medications after 1 year of follow-up compared to phaco-ECP, particularly when 2 or more stents are used. Both groups showed an overall good safety profile.

Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade.

Combining two or more MIGS (cMIGS) promises to be more efficacious than single MIGS (sMIGS). This study compared the efficacy of PEcK, which combines Phacoemulsification (Phaco), Endocyclophotocoagulation (ECP), and Kahook dual blade (KDB), relative to both of its constituent sMIGS, Phaco/ECP (Endo Optiks, NJ) and Phaco/KDB (New World Medical, CA) for the first time. Data was collected retrospectively from 1833 visits of 271 patients who underwent PEcK, Phaco/ECP, or Phaco/KDB from 2016-2021 at Massachusetts Eye and Ear. Primary outcomes included Generalized Estimating Equations (GEE) of intraocular pressure (IOP) and medication burden, as well as survival models. Mean preoperative IOP was 17.6 ± 5.0 (SD) mmHg on 3.0 ± 1.4 medications in the PEcK group (n = 128), 17.9 ± 5.1 mmHg on 2.2 ± 1.5 medications in the Phaco/ECP group (n = 78), and 16.1 ± 4.3 mmHg on 0.4 ± 1.0 medications in the Phaco/KDB group (n = 65). For more than 36 months, all procedures resulted in significant patterns of IOP and medication reduction (all p < 0.001), before and after statistical adjustment. The reduction pattern in IOP was significantly different when comparing all groups over time and favored PEcK (p = 0.04), but the reduction pattern in medications was not significantly different (p = 0.11). Procedures did not differ in procedural time (p = 0.18) or in survival to maintain ≥20% IOP reduction (p = 0.43) without additional medication or procedure. There was a trend toward significant difference in maintaining IOP ≤ goal IOP that favored PEcK over Phaco/ECP after adjustment (p = 0.09). PEcK may confer greater IOP reduction without added procedural time compared to Phaco/ECP and Phaco/KDB in predominantly mild or moderate glaucoma. Further research on cMIGS may benefit from adopting this comparative analysis to constituent MIGS.

Plateau Iris: A Review.

To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management. This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management. This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned. Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

Outcomes of chronic angle-closure glaucoma treated by phacoemulsification and endocyclophotocoagulation with or without endoscopically goniosynechialysis

To investigate the surgical outcomes of patients with chronic angle-closure glaucoma (CACG) treated with phacoemulsification (phaco)/endocyclophotocoagulation (ECP) with and without endoscopic goniosynechialysis (E-GSL). A retrospective, nonrandomized, comparative case series was conducted. Patients with CACG who underwent phaco in combination with either ECP alone (ECP group) or GSL with ECP (E-GSL group) from 2018 to 2019 were followed for 12mo and reviewed. Clinical features and outcomes were identified and analyzed. The ECP and E-GSL groups were matched in age and baseline intraocular pressure (IOP). Changes in IOP, mean of visual acuity (VA), peripheral anterior synechiae (PAS) formation, and the number of glaucoma medications was examined. The ECP group included 32 eyes of 27 patients, and the E-GSL group included 32 eyes of 26 patients. The preoperative baseline IOP was 22.18±6.48 mm Hg in the ECP group and 22.95±6.71 mm Hg in the E-GSL group (P=0.644). The mean IOP reduction was 26.2% in the ECP group and 41.6% in the E-GSL group at 12mo. The mean postoperative VA (logMAR units) at 12mo was 0.47 in the ECP group and 0.36 in the E-GSL group. The reduction in PAS formation and the number of glaucoma medications was also higher in the ECP group than E-GSL group at 12mo. The phaco/ECP and phaco/E-GSL groups both achieve a significant reduction in IOP without complications associated with traditional glaucoma filtration surgeries.

Refractive Outcomes of Cataract Surgery With or Without Endocyclophotocoagulation.

Surgeons that perform cataract surgery combined with endocyclophotocoagulation (ECP) should rely on their preferred intraocular lens (IOL) calculation formula. There is no need to perform any correction to the IOL power, as this procedure does not modify the refractive outcome. The purpose of this study was to compare postoperative refractive outcomes in patients with glaucoma who underwent phacoemulsification and IOL implantation with or without ECP and the change in intraocular pressure (IOP) and number of antiglaucoma medications between groups. A cross-sectional study in which the medical records of the patients with any type of glaucoma, who underwent phacoemulsification with IOL implantation in the capsular bag in addition to ECP or as a standalone procedure from June 2016 to August 2019 were analyzed. Clinical data collected included axial length, steep, flat, and mean keratometry values, target spherical equivalent (SE) estimated by the SRK/T formula, manifest refraction SE at the 1-month follow-up, IOP, and number of antiglaucoma medications before and 12 months after surgery. Primary and secondary outcome measures were the mean predictive error (MPE), the postoperative SE, and the change in IOP after surgery in both groups, respectively. Significance was assessed using the Student t test for all variables between groups according to data distribution. P-values <0.05 were considered to be statistically significant. A total of 196 eyes of 196 patients were included, 98 in the combined phacoemulsification-ECP group, and 98 in the non-ECP group. The observed MPE was -0.043±0.44, and 0.06±0.38 D MPE, respectively (P=0.079). Overall, 74.34% in the phacoemulsification-ECP group and 78.4% in the non-ECP group had a postoperative SE of ±0.50. The ECP group had lower IOP and a greater decrease in antiglaucoma medications at 12 months of follow-up. SRK/T formula performed well in both groups, with no statistically significant difference in the MPE and the percentage of eyes achieving postoperative SE of ±0.50. We consider it is unnecessary to perform any kind of correction to the IOL power calculation when performing ECP.

Outcomes of phacoemulsification combined with two iStent inject trabecular microbypass stents with or without endocyclophotocoagulation

AimComparing outcomes after combined phacoemulsification, two iStents insertion and endocyclophotocoagulation (ECP) versus phacoemulsification-iStents alone.MethodsThis is a longitudinal retrospective 12 months study in eyes with ocular hypertension or early-to-moderate open angle...

Primary Outcomes of Patients with Chronic Angle-Closure Glaucoma Treated with Combined Phacoemulsification, Viscogoniosynechialysis, and Endocyclophotocoagulation.

Purpose/Objective To evaluate the effectiveness of combined phacoemulsification, viscogoniosynechialysis (VGSL), and endocyclophotocoagulation (ECP) in patients with moderate chronic angle-closure glaucoma (CACG) with peripheral anterior synechia (PAS) ≥90 not controlled with glaucoma medications and previous iridotomy yag laser. Materials and Methods We retrospectively reviewed records from patients with cataract and uncontrolled chronic angle-closure glaucoma despite maximal tolerated medical therapy and iridotomy yag laser who received combined treatment with phacoemulsification with posterior capsular lens implantation, VGSL, and ECP 360°. We evaluated intraocular pressure (IOP), glaucoma medications, and best corrected visual acuity (BCVA) preoperatively and during follow-up.Results A total of 29 eyes from 22 patients received surgical intervention. Mean follow-up was 6 months. Mean preoperative IOP was 18.2 mmHg, and postoperatively, IOP was 13.5, 12.2, and 12.8 mmHg at 1, 3, and 6 months, respectively. Complete success was 37.9%, and relative success was 72.4%. Mean BCVA was 0.4 logMAR preoperative and 0.3 logMAR 6 months after surgery. Glaucoma medication fell significantly from 2.34 ± 1.66 preoperatively to 1.31 ± 2.6 postoperatively (p < 0.001). Overall, 44.8% of the patients did not require glaucoma medications at 6 months. There were no visual significant complications. Conclusion Combined treatment with phacoemulsification with posterior capsular lens implantation, VGSL, and ECP is effective and safe in reducing IOP and number of glaucoma medications with stable BCVA at 6 months.

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

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

Seven- and eight-year trends in resident and fellow glaucoma surgical experience.

PurposeThis study evaluated US resident and fellow glaucoma surgical experience over a 7- and 8-year period, respectively.MethodsUS ophthalmology resident glaucoma case logs from 2009 to 2016 and glaucoma fellow case logs from 2008 to 2016 were reviewed. The number of total, average, median, and minimum cases, along with percentile data for filtering surgery, shunting surgery, and novel procedures were analyzed for year-to-year trends.ResultsAmong residents training from 2009 to 2016, there was a decline in the average number of primary filtering surgeries by 20%, from 6.0±5.0 to 4.8±4.0 cases, with a concurrent increase in average primary glaucoma drainage implant (GDI) surgeries by 40%, from 4.5±4.0 to 6.3±5.0 cases, which represented an increase of 6.5% per year, P<0.001. Glaucoma fellow data from 2008 to 2015 demonstrated a decline in average primary trabeculectomy surgeries by 3.7%, from 30.1 to 29.0 cases, but then increased to 32.1 cases in 2015–2016. There was an increase in average GDI surgeries by 57.9%, from 30.2 to 47.7 cases for fellows over this 8-year period, which represented a 5.9% increase per year, P<0.001. There was no microinvasive glaucoma surgery (MIGS) or other novel procedures reported in the Accreditation Council for Graduate Medical Education (ACGME) resident case logs. From 2008 to 2016, Association of University Professors of Ophthalmology (AUPO) glaucoma fellow case logs demonstrated an increase in endocyclophotocoagulation (ECP) from 2.3 to 5.4 cases, a 15.5% increase per year, P<0.001.ConclusionsOver a 7–8-year period, trainee surgical experience with GDI surgery has steadily increased, whereas surgical experience with trabeculectomy has been fluctuating and may be on a downward trend. Educators should be aware of shifts in trainee surgical experience in order to maintain appropriate training experience.

Effect of phenylephrine 1.0%–ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy-iris syndrome

To determine the effect of phenylephrine 1.0%-ketorolac 0.3% injection (Omidria) on different components of intraoperative floppy-iris syndrome (IFIS). Silverstein Eye Centers, Kansas City, Missouri, USA. Prospective case series. Men treated with tamsulosin having standard cataract extraction surgery were placed in a treatment group that received phenylephrine 1.0%-ketorolac 0.3% injection in the irrigation solution and a control group) that received basic saline solution. Every procedure was video recorded using an endocyclophotocoagulation (ECP) probe and microscopic view. Pupil dilation, iris billowing, and iris prolapse were measured using a micrometer, ECP recording grading scale, and microscopic recordings, respectively. Each group (treatment and control) comprised 25 eyes of 25 patients. Although both groups had a decrease in pupil diameter before and after cataract extraction and before cataract extraction and after intraocular lens implantation, the changes were statistically significantly greater in the treatment group. Iris prolapse occurred in 3 patients (12.0%) in the treatment group and 14 patients (56.0%) in the control group (P<.001). Stage 3 (severe) pupil billowing occurred in 1 eye (4.0%) in the treatment group and 10 eyes (40.0%) in the control group (P<.001). The use of the phenylephrine 1.0%-ketorolac 0.3% injection combination added to the irrigating solution during cataract surgery in patients at risk for IFIS led to significantly better prevention of miosis, less pupil billowing, and a reduced incidence of iris prolapse. A new grading scale for intraoperative iris abnormalities might be used for future evaluation.

Phacoemulsification and endocyclophotocoagulation in uncontrolled glaucoma: Three-year results

To describe the 3-year outcomes of combined cataract surgery and 360-degree endocyclophotocoagulation (ECP) in eyes with uncontrolled glaucoma and no previous glaucoma drainage surgery. University Hospital Eye Department, Exeter, United Kingdom. Retrospective case series. The study included patients who had combined cataract surgery and 360-degree ECP. The primary outcome measure was intraocular pressure (IOP) reduction at 3years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 3years and the complications of surgery. Failure was defined by 1 of 2 criteria: (1) IOP higher than 21mm Hg or lower than 6mm Hg or not reduced by 20% from baseline at the 1-, 2-, or 3-year timepoint and (2) further laser or other surgery to reduce IOP at any timepoint. The study comprised 84 patients (84 eyes). The mean IOP dropped from 18.7mm Hg preoperatively to 13.3mm Hg, 13.8mm Hg, and 14.0mm Hg at 1, 2, and 3years postoperatively, respectively. By the 3-year timepoint, 58.3% had met the criteria for failure. The mean number of glaucoma medications was similar at 2.5 at 3years postoperatively compared with 2.6 preoperatively. Nine patients (10.7%) had a significant complication, but all resolved without long-term sequelae. At 3years postoperatively, combined cataract surgery and 360-degree ECP achieved a modest but significant drop in IOP in phakic patients with uncontrolled glaucoma and no previous drainage surgery. There was a low incidence of serious side effects but nearly 60% were classified as failures by 3years.

Combined glaucoma and cataract surgery: Comparison of viscocanalostomy, endocyclophotocoagulation, and ab interno trabeculectomy

To compare outcomes of phacoemulsification combined with viscocanalostomy, endocyclophotocoagulation (ECP), or ab interno trabulectomy for intraocular pressure (IOP) control and safety in eyes with open-angle glaucoma and visually significant cataract. Farabi Eye Hospital, Tehran, Iran. Retrospective case series. Medical records of patients who had combined surgery and were followed for at least 1year were reviewed. Complete success, postoperative IOP, number of medications at each visit, and complications were evaluated and compared before and after adjustments for confounders. Forty-six eyes had combined phacoviscocanalostomy, 35 had phaco-ECP, and 28 eyes phaco-ab interno trabulectomy. The groups were matched for baseline IOP (P=.24). At thefinalfollow-up (mean 17.2months±5.5 [SD]), the phacoviscocanalostomy group had the lowest mean IOP (13.5±4.7mm Hg, 29% decrease) (P=.01). There was no significant difference in the final IOP between phaco-ECP and phaco-ab interno trabulectomy (16.4±3.9mm Hg, 20% decrease versus 15.8±4.2mm Hg, 15% decrease) (P=.88). The reduction in the number of medications was greater with phacoviscocanalostomy (77%) than with phaco-ECP (40%) and phaco-ab interno trabulectomy (44%) (P=.01). Phacoemulsification-ab interno trabulectomy had the fewest complications. Intraocular pressure spikes were more frequent in the phaco-ECP group (20%) than in the other groups (4%) (P=.05). All procedures significantly lowered IOP. Phacoemulsification-ab interno trabulectomy resulted in fewest complications and phacoviscocanalostomy led to the largest IOP drop and largest reduction of medications.

Clinical Results of Endocyclophotocoagulation in Patients with Cataract and Open-Angle Glaucoma at Oftalmosalud Eye Institute, Lima-Peru

Purpose: To describe the clinical results of the endocyclophotocoagulation (ECP) in patients with Cataract and Open-angle glaucoma with 2 years follow up (Lima, Peru). Methods: A retrospective study, included 41 eyes that evaluates the results of the Phaco+ECP performed 2011 and 2013 at Oftalmosalud Eye Institute in Lima, Peru. It was evaluated best corrected visual acuity (BCVA) and intraocular pressure (IOP) preoperatively and 1 day, 1 month, 6 months, 1 year, and 2 years after ECP, and the number of anti-glaucomatous drugs administered was noted preoperatively and at 1 and 2 years after surgery. Success rate was defined as IOP ≤ 18 mmHg with or without medication at 1 and 2 years postop. Results: The mean BCVA was 0.7 ± 0.6 preoperatively, 1.0 ± 0.8 at day 1, 0.4 ± 0.5 at 1 month, 0.3 ± 0.5 at 6 months, 0.3 ± 0.5 at 1 year, and 0.3 ± 0.5 at 2 years. A significant difference in the preoperative BCVA value was observed in comparison with 1day post op, but not difference was found between the preoperative value and the control at 1 and 2 years. Mean intraocular pressure was 22.0 ± 8.3 mmHg preoperatively, 16.0 ± 6.5 mmHg at 1 day, 15.4 ± 5.4 mmHg at 1 month, 14.0 ± 4.5 mmHg at 6 months, 13.7 ± 3.3 mmHg at 1 year, and 12.9 ± 2.3 mmHg at 2 years. The reduction of the intraocular pressure from the preoperative period and the control at 2 years was statistically significant. The mean number of antiglaucomatous drugs administered, had a significantly decrease from 2.08 ± 0.87to 1.60 ± 0.94 at pre and 2 year follow up respectively. Conclusion: ECP is a treatment that reduces IOP in patients with cataract and open-angle glaucoma.

Microbypass stent implantation with cataract extraction and endocyclophotocoagulation versus microbypass stent with cataract extraction for glaucoma

To compare the outcomes of combined microbypass stent implantation, cataract extraction, and endocyclophotocoagulation (ECP) with those of implantation of the same microbypass stent with concomitant cataract surgery in patients with open-angle glaucoma (OAG). Private Practice, Sioux Falls, South Dakota, USA. Retrospective consecutive case series. Patients from January 2015 to August 2016 were included. The study group comprised eyes that had implantation of a microbypass stent in combination with cataract extraction and ECP. To compare outcomes, a control group of eyes with similar baseline characteristics that had implantation of a stent in combination with cataract surgery was established. Data were collected preoperatively and postoperatively at 1day, 1week, and 1, 3, 6, and 12months. Data included intraocular pressure (IOP) and number of glaucoma medications. The mean preoperative IOP was 21.49mm Hg±9.56 (SD) in the study group (51 eyes) and 20.66±3.23mm Hg in the control group (50 eyes). Twelve months postoperatively, the mean IOP reduction was 7.14mm Hg in the study group and 4.48mm Hg in the control group and the medication reduction was 38% (0.68) and 63% (1.06), respectively. Patients who had implantation of the microbypass stent in combination with cataract surgery and ECP had significantly better IOP reduction than those who did not have ECP. The combination procedure was also effective in patients with severe OAG.

Effect of endocyclophotocoagulation on refractive outcomes in angle-closure eyes after phacoemulsification and posterior chamber intraocular lens implantation

To compare postoperative refractive outcomes in angle-closure eyes having phacoemulsification and intraocular lens (IOL) implantation with or without endocyclophotocoagulation (ECP). Single tertiary-level ophthalmology practice. Retrospective comparative study. Primary angle-closure suspect (PACS), primary angle-closure (PAC), or primary angle-closure glaucoma (PACG) eyes that had phacoemulsification and IOL implantation with or without ECP from 2012 to 2014 were studied. Clinical data collected included axial length (AL), minimum and maximum keratometry (K) values, corneal powers, anterior chamber depth (ACD), corneal white-to-white (WTW), implanted IOL power, and postoperative manifest refraction. The Holladay 1 formula was used for IOL calculations. Primary and secondary outcome measures were the mean absolute error (MAE) and mean arithmetic error, respectively. Sixty-eight eyes with ECP and 71 eyes without ECP were included. There were no statistically significant differences between the 2 groups in age, sex, eye side, ethnicity, AL, minimum or maximum keratometry values, ACD, WTW, or implanted IOL power. The MAE was lower in the non-ECP group (0.47 ± 0.32D versus 0.62 ± 0.43D; P = .0285). The mean arithmetic error showed a more myopic result in the ECP group (-0.54 ± 0.53D versus -0.26 ± 0.52D; P = .0017). In this study, patients with PACS, PAC, or PACG having phacoemulsification and IOL implantation with ECP had decreased predictability of the postoperative refraction and a small myopic shift compared with those without ECP. Dr. Ahmed is a consultant to Alcon, Advanced Medical Optics, Bausch & Lomb, and Carl Zeiss. None of the other authors has a proprietary or financial interest in any material or method mentioned.

Achieving controlled intraocular pressure and restoration of vision following proactive treatment of total choroidal detachment due to endocyclophotocoagulation

Ocular hypotony due to choroidal detachment (CD) following endocyclophotocoagulation (ECP) is transient. If hypotony lasts for more than 1 week, it could affect vision. This is a case of refractory glaucoma following cataract surgery that was managed by ECP. We drained subchoroidal fluid as CD did not resolve after 1 week. After 5 months, the intraocular pressure was restored to 16 mmHg with one topical glaucoma medication, uncorrected vision improved to 20/300, and with aphakic soft contact lens, it was 20/50. Ophthalmologists facing such complications need not panic and manage hypotony, and the prognosis of such intervention seems to be promising.

Évaluation de l’efficacité de l’ECP à laser diode combinée à une chirurgie de cataracte dans le glaucome

Surgical techniques, which reduce the secretion of aqueous humor are underutilized in the surgical management of glaucoma; the diode laser coupled to an endoscope, endocyclophotocoagulation (ECP), is an emerging technology in the treatment of glaucoma. Indeed, thanks to its direct, focal and controllable approach to diode laser treatment of the ciliary processes, ECP renders this a safer technique compared to transscleral diode laser. We present preliminary results and an evaluation of the efficacy of ECP combined with cataract surgery performed at the Al Bassar clinic in Mohammedia, Morocco. We conducted a retrospective study on a series of 82 patients who underwent combined surgery: diode laser endocyclophotocoagulation and cataract for treatment of glaucoma during the period from December 2012 to July 2013. For this study, we recorded: age and gender of the patients, number and power of diode laser spots, pre- and postoperative intraocular pressure (IOP), and the number of anti-glaucoma treatments prescribed pre- and postoperatively (3 months minimum). Technically, a 20-gauge endo-ocular probe is inserted through the corneal incision used for phacoemulsification. The probe is equipped with a light source, a camera and a pulsed 810 nm laser beam; it is connected to an Endo-optiks type generator, which allows for direct visualization of the ciliary processes and their precise treatment. The surgical procedure is both simple and quick. Postoperative follow-up is unchanged from the management of cataract extraction by phacoemulsification. The average age in our series was 69.5 years (range 33-81 years), mean follow-up was 5.7 months. The reduction in intraocular pressure was 28.5%. In 40% of patients, a significant reduction in medications was noted, and in 20%, a total suspension of anti-glaucoma medications. No serious complications were noted in our series. This technique can perfectly fit into the medical, natural and/or surgical armamentarium medical, physical, surgical to halt progression of glaucomatous disease. The IOP lowering obtained by this combined surgery is significantly greater than that obtained after phacoemulsification alone in open-angle glaucoma. It can accommodate many situations for which conventional surgery has limitations. In addition, this technique has the advantage of preserving the bulbar conjunctiva for any subsequent glaucoma surgeries. Our preliminary results are very satisfactory. This combined technique is simple, safe and effective. This allows broadening of its indications to include moderate glaucoma, stabilized or not, in addition to refractory glaucoma. Also, from an economic point of view, the gain for the patient is significant. Of course, longer-term follow-up is required to confirm these results.

Endocyclophotocoagulation as an Adjuvant to Vitreoretinal Surgery in Cases With Concomitant Glaucoma

To evaluate the efficacy of endocyclophotocoagulation (ECP) in patients undergoing pars plana vitrectomy for vitreoretinal disease with medically uncontrolled glaucoma. This is a retrospective review of 12 patients who underwent 270° ECP following vitrectomy. Ten of the 12 patients had excellent intraocular pressure (IOP) control postoperatively, without medication in four patients and with reduced medication in six patients. IOP decreased from 26.3 ± 12.9 to 17.9 ± 6.0 at 1 month (P = .03) and 16.9 ± 4.4 at 3 months postoperatively (P = .02). Best corrected visual acuity was improved by 1 month postoperatively. The number of glaucoma agents decreased from 2.7 ± 1.1 to 1.3 ± 1.3 (P = .03). One patient with neovascular glaucoma developed hypotony. Postoperative inflammation or discomfort did not exceed what was expected for a standard vitrectomy in any patient. ECP can be effectively combined with vitrectomy; however, ECP produced unpredictable results in the two patients with neovascular glaucoma.

Cataract surgery assisted by anterior endoscopy

Aim:The aim of the present study is to evaluate the feasibility of endoscopy-assisted phacoemulsification, intraocular lens (IOL) implantation and anterior segment manoeuvres like synechiotomy where conventional surgery through a microscope...