Endoscopic Cyclophotoagulation vs Tube Implantation in Neovascular Glaucoma: A prospective, Randomized, Long Term Controlled Study.

Martin Uram, M.D., M.P.H.

Retina Consultants, Little Silver, New Jersey, USA

Purpose: To determine the relative efficacy and safety of endoscopic cyclophotocoagulation (ECP) compared to Ahmed valve implantation in the setting of neovascular glaucoma (NVG).

Methods: 65 eyes of 65 patients were randomized by the statistician to treatment by ECP (34 eyes) or Ahmed valve implantation (31 eyes). Assessment of pre- and post-operative acuity, IOP, glaucoma medications, and complications were made. All eyes were pseudophakic. Exclusion criteria included NLP vision and previous tube implantation or cyclodestructive procedure. Success was defined as maintaining IOP between 5 and 22 mmHg with or without medications.

Results: Mean follow-up was 4.1 years (1.5 to 12.0). Pre-operative IOP was 40.3 +/- 3.1 mmHg ECP, 41.7 +/- 3.4 mmHg valve (p=0.6). Post-operatively, IOP was 12.6 +/- 6.1 mmHg ECP and 15.2 +/- 8.9mmHg valve (p=.0005). Number of pre-op meds ECP was 3.7 +/- 1.6 and 3.5 +/- 1.8 valve (p=0.7). Post-operatively this declined to 1.5 +/- 1.1 ECP and 2.0 +/- 1.7 valve (p=.0005). Complications included visual loss 21% (7/34) ECP vs 26% (8/31) valve eyes, choroidal detachment 3% (1/34) ECP vs 23% (6/31) valve, hypotony/phthisis 6% (2/34) ECP vs 13% (4/31) valve.

Conclusion: ECP demonstrated greater efficacy and safety then Ahmed valve implantation in this long-term randomized, controlled study.