This article is more than 5 years old. Information may no longer be current.
Study finds aphakic, pseudophakic children best suited for ECP
Click Here to Manage Email Alerts
KEYSTONE, Colo. — Endoscopic cyclophotocoagulation produced better outcomes in aphakic and pseudophakic children than in children with other glaucoma etiologies, according to B. Christian Carter, MD.
Dr. Carter presented the results of a retrospective study at the American Association for Pediatric Ophthalmology and Strabismus meeting here. He said previous studies conducted by his group have found the success rate of endoscopic cyclophotocoagulation (ECP) to range from 43% to 50%, depending on which study was referenced. Dr. Carter and colleagues wanted to single out the aphakic and pseudophakic subpopulations to see what their success rates would be.
“Aphakic glaucoma is a very common disease after extraction of congenital cataract,” Dr. Carter said. “The incidence can be about 35%, and is primarily an open angle disease.”
Dr. Carter and colleagues studied 34 eyes of 25 patients, the majority of which were aphakic. Patients whose aphakia was related to congenital glaucoma were excluded from the study, as well as those with anterior segment dysgenesis.
ECP was performed with the Microprobe (Endo Optiks) integrated laser endoscope system. Patients were followed for a minimum of 12 months, or until treatment failure was declared. Failure was defined as patients with IOP greater than 24 mm Hg, despite the use of medication, or the need for any further intervention that was not ECP, Dr. Carter said. The development of any visually threatening complications was also considered failure, he added.
The study found a 59% overall success rate, with a mean of 1.5 treatments per eye.
The mean baseline IOP was just under 32 mm Hg and mean follow up was 44 months, he said.
The mean age at the time of surgery was just over 4 years old. For more than 80% of the eyes in the study, ECP was the first intervention to lower IOP. Sixty two percent of eyes underwent a single treatment, and 38% underwent multiple treatments. In the single-treatment group, there was a 67% success rate.
Medications were not greatly affected by the interventions, he noted. Over half the treatment successes (55%) required no postoperative glaucoma medication.
Out of 52 total procedures, there were two vision-threatening complications from retinal detachment. There was no evidence of hypotony in any patient, despite nearly 25% of the patients receiving 360· of laser treatment.
Dr. Carter said the good results and low complication rate indicate that aphakic and pseudophakic patients might be “the subgroup best suited for this intervention.”
“The 59% overall success rate is greater than what we have previously attained with endolaser when applied to various other etiologies of pediatric glaucoma,” he said.