Endocyclophotocoagulation ECP As an Effective Sustaining IOP Reducer in Advancing Stages of Glaucoma

Endocyclophotocoagulation (ECP) As an Effective Sustaining IOP Reducer in Advancing Stages of Glaucoma

2021

Author: Kristen Hawthorne, MD, ABO

Contributors: Apurva Chavali MS, Daniel Godoy BSc

Purpose:

To evaluate surgical outcomes in chronic glaucoma patients who were treated with endocyclophotocoagulation (ECP) at the time of cataract surgery with or without additional MIGS procedures. Determination of whether ECP is a MIGS tool that offers sustained efficacy with a minimal side effect profile in surgical glaucoma patients.

Methods:

A retrospective chart analysis of 98 eyes with glaucoma that were treated by a single surgeon with ECP, ECP + iStent or ECP + goniotomy at the time of CE/IOL. Stage of glaucoma, efficacy of intraocular pressure (IOP) lowering effect, reduction of medication burden, visual acuity changes over time, side effect profile, complications and need for additional procedures were examined. 35 patients had data collected greater than 24 months with a maximum follow up time of 68 months. Paired t-tests were done to determine if IOP lowering effect was sustained years after treatment. Graphical representation of results provided for BCVA, IOP lowering effect and change in medication burden over time.

Results:

The level of statistical significance chosen was (α = 0.05). 89% of eyes had moderate or severe glaucoma. All procedures (ECP, ECP + iStent and ECP + goniotomy) showed a significant decrease in IOP at 1 month, 6 months and 1 year. At 1-year, average IOP decreased in ECP from 18.737.55mmHg to 143.07mmHg, in ECP + iStent from 17.873.95mmHg to 15.414.12mmHg and in ECP + goniotomy from 18.534.21mmHg to 12.752.92mmHg. ECP and ECP + iStent showed a significant decrease in IOP at 2 years, 3 years and 4 years. Insufficient data available for ECP + goniotomy at 24 months and beyond. At most time points there was not a significant reduction in medication burden in this cohort of patients.

Conclusions:

ECP has few side effects and offers a sustained IOP lowering effect in glaucoma patients with advancing disease. Minimal discontinuation of topical medications may be expected to reach IOP reduction goals in this cohort. ECP with or without combined MIGS procedures may delay conjunctival incisional therapy in advancing glaucoma for years.