4/3/2016 U F G Universidade Federal de Goiás C B C O Centro Brasileiro de Cirurgia de Olhos A Prospective, Comparative Study Between Endoscopic Cyclophotocoagulation.

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4/3/2016 U F G Universidade Federal de Goiás C B C O Centro Brasileiro de Cirurgia de Olhos A Prospective, Comparative Study Between Endoscopic Cyclophotocoagulation and the Ahmed Drainage Implant in Refractory Glaucoma Francisco E. Lima, MD Goiânia, Brazil

Endoscopic Cyclophotocoagulation Cyclodestructive procedures

Purpose To compare endoscopic cyclophotocoagulation (ECP) and the Ahmed drainage implant in the treatment of refractory glaucoma.

Methods One hundred-eight eyes of 180 patients with refractory glaucoma were prospectively assigned to either ECP or Ahmed tube shunt implantation. All procedures were performed by a single surgeon (F.E.L.)

Eyes that were included had a history of at least one trabeculectomy with antimetabolite, an intraocular pressure (IOP) equal to or above 35 mmHg on maximum tolerated medical therapy, and a visual acuity better than 20/200. Methods

Exclusion criteria included eyes that had had previous glaucoma drainage device implantation or a cyclodestructive procedure. Success was defined as an IOP more than 6 mmHg and less than 21 mmHg, with or without topical anti-hypertensive therapy. Methods

Methods The procedure was performed by a limbal or pars plana incision, with laser power ranging from 0.5W to 0.9W, continuous mode to produce both whitening and shrinkage of the ciliary processes. ECP was done to 210º of the ciliary body, corresponding to 2 to 9 hours in the right eye and from 3 to 10 hours in the left eye, including the anterior third of the pars plana.

The mean follow-up was  9.36 months and  8.24 months, for the Ahmed and ECP groups, respectively (p = 0.3). The pre-operative IOP,  5.33 mmHg (Ahmed) and  6.57 mmHg (ECP) (p = 0.5), and the mean postoperative IOP, at 36 months follow-up,  5.51 mmHg (Ahmed) and  6.32 mmHg (ECP) (p = 0.6), were significantly different from baseline in both groups (p<0.001). Results

Results Kaplan-Meier survival curve analysis showed a probability of success at 36 months of 75.93% and 72.22% for the Ahmed and ECP groups respectively (p = 0.6). Complications included choroidal detachment (Ahmed 15%, ECP 2%), shallow anterior chamber (Ahmed 16%, ECP 0.0%) and hyphema (Ahmed 12%, ECP 13%).

There was no difference in the success rate between the Ahmed Glaucoma Valve and ECP in refractory glaucoma. The eyes that underwent Ahmed tube shunt implantation had more complications than those treated with ECP. Conclusions