Long-term Efficacy and Safety of Posterior Endoscopic Cyclophotocoagulation in Refractory Glaucoma: A 5-Year Follow-up Study at a Tertiary Eye Center.

PURPOSE: To evaluate the long-term efficacy of endoscopic cyclophotocoagulation (ECP) via a pars plana approach in a large cohort of refractory glaucoma patients DESIGN: Single-center, retrospective, longitudinal, cohort study.

METHODS: This study recruited patients who underwent ECP and consecutively visited and were followed up for at least 5 years at Beijing Tongren Eye Center, China from January 2013 to December 2017. All patients underwent a complete ophthalmic examination. Treatment success was defined as 6mmHg ≤ IOP ≤ 21mmHg with or without anti-glaucoma medications.

RESULTS: A total of 121 eyes of 105 patients including 51 children and 54 adults were enrolled. The mean follow-up was 7.2±1.3 years. The most common glaucoma diagnoses were secondary glaucoma (74 eyes, 61.1%) and primary congenital glaucoma (19 eyes 15.7%). The mean extent of the first ECP was 259 degrees. There was an overall decrease in IOP of 38.3% from 33.3±9.0mmHg preoperatively to 20.5±7.5mmHg after surgery, which was statistically significant (P < 0.001). The success rate after 1 or more ECP surgery was 65.3%. After adjusting for sex, number of prior TCP surgeries and the extent of ECP degree, the failure of ECP was associated with being children (as compared with adults; P = 0.028; OR = 2.549) and higher preoperative IOP (P = 0.001; OR = 1.084).

CONCLUSION: ECP is an effective procedure for lowing IOP in refractory glaucoma, particularly in patients who are also candidates for vitreoretinal interventions. Hence, a collaborative approach between glaucoma and retinal specialists is of utmost importance in devising an optimal management strategy for glaucoma treatment.