Endoscopic cyclophotocoagulation combined with pars plana vitrectomy yields intraocular pressure reduction

Endoscopic cyclophotocoagulation combined with pars plana vitrectomy is a safe and highly effective technique for treating elevated IOP in pseudophakic eyes.

Dr. Pokabla presented results from a series of six eyes of six patients (mean age 58.5 years) that underwent ECP with PPV at the University of Pittsburgh Medical Center (UPMC).

Mean preoperative IOP for the group was 23.5 mm Hg and each patient was using an average of two topical medications daily. On the first postoperative day, mean IOP had decreased to 14.7 mm Hg, and after an average follow-up of 120 days, mean IOP was just 6 mm Hg without any patients requiring topical IOP-lowering therapy.

Currently, Dr. Pokabla is a glaucoma specialist in private practice at the Carle Clinic, Champaign, IL.

"The experience in this series supports use of ECP with PPV as a replacement for or supplement to other glaucoma surgical procedures to provide a clinically significant reduction of elevated IOP in pseudophakic eyes," Dr. Pokabla added.

ECP was performed using a proprietary laser and endoscopy system (E2 MicroProbe, Endo Optiks) and PPV was performed with equipment commonly used for anterior vitrectomy (Infiniti Vision System, Alcon Laboratories) and an anterior chamber maintainer.

Some eyes underwent ECP plus PPV only, some had a history of prior glaucoma surgery, and others underwent simultaneous shunt surgery.

Limited anterior vitrectomy

The procedure begins with a limited anterior vitrectomy that aims to clear out vitreous near the ciliary body and ciliary body processes and to prevent vitreous traction on the retina.

Then, depending on the intended area of treatment, either one or two pars plana incisions are made with a 20-gauge microvitreoretinal blade. The ECP probe is inserted through the pars plana incision(s) and the laser is used to treat a zone ranging from 180° to 270°.

Dr. Pokabla said he prefers the curved versus straight probe because he believes the curved probe enables treatment of a larger area with less manipulation of the eye.

The procedure was very well tolerated, he said. One patient developed transient hypotony that was self-limited and there were no major complications.

"It is important to confirm water-tightness of the pars plana incisions, and due to the amount of treatment, patients receive a fairly aggressive course of postoperative corticosteroids," Dr. Pokabla concluded. "However, complications with ECP and PPV are similar to those of ECP through a clear cornea approach and standard PPV."

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