Intraocular pressure reduced with surgical procedure

October 15, 2009

Endoscopic cyclophotocoagulation seems to be a safe and easy treatment for glaucoma that provides patients with rapid recovery.

"In glaucoma surgery, there are two ways to address the problem of elevated IOP," said Dr. Noecker, associate professor and vice chairman, Department of Ophthalmology, and director of the glaucoma service, University of Pittsburgh Medical Center.

"One approach is to reduce the production of aqueous, and the other [approach] is to increase the outflow of aqueous," he said. "ECP is a procedure that decreases aqueous production by selectively ablating the ciliary epithelium which produces aqueous. During the procedure, the laser energy shrinks the ciliary processes upon which the ciliary epithelium resides, which allows us to titrate the treatment depending on how much treatment is needed. How many ciliary processes should be treated to reduce the aqueous production depends on the the goal to which IOP should be lowered. The procedure is visualized directly, endoscopically inside the eye, making it safer than previous non-visualized procedures."

In addition, surgeons can perform ECP under topical anesthesia in conjunction with cataract surgery and can take advantage of using the cataract incision to enter the eye.

Follow-up

Dr. Noecker described the 5-year results of outpatient procedures that were performed by Farrell C. Tyson II, MD, FACS, a refractive-cataract/glaucoma surgeon at the Cape Coral Eye Center in Florida. In that study, all patients had well-controlled glaucoma and were undergoing cataract surgery.

Patients' preoperative IOP values ranged from 11 to 21 mm Hg, with an average of 16.98 mm Hg. The number of preoperative medications ranged from 0 to 4, with an average of 1.56. All patients underwent postoperative evaluations at 1 day; 1 week; 1, 3, 6, and 9 months; and 1 year, and then every 3 months up to the 5-year time point. During follow-up, glaucoma medications were added or subtracted as needed to maintain the IOP.

"At 5 years of follow-up, the average number of medications decreased 60% to 0.9 medications, with an additional IOP reduction of 16% to 14.77 mm Hg, on average," Dr. Noecker said. "At one year postoperatively, 61% of eyes treated did not require any anti-glaucoma medications to sustain the IOP level, and 76% of eyes were off one or more glaucoma medications."

These results are consistent with those of previously reported studies. The side effects of ECP are similar to those seen with cataract surgery, he said.

Dr. Noecker said he performs ECP frequently in his practice. His experience is consistent with the results of this study, but his published follow-up is shorter.

The importance of the study under discussion is the length of the follow-up period.

"When treating patients with glaucoma, a lot of approaches will work for a short time, that is, 6 months," he concluded. "But these data are so reassuring because a large number of eyes were followed for up to 5 years after the procedure."