title: Endoscopic Cyclophotocoagulation and Pars Plana Ablation (ECP-plus) to Treat Refractory Glaucoma.
abstract: OBJECTIVE
  To report clinical outcomes after pars plana endoscopic cyclophotocoagulation of the ciliary processes and pars plana (ECP-plus), a novel treatment for refractory glaucoma.
  
  
  METHODS
  Retrospective, noncomparative interventional case series.
  
  
  METHODS
  
  
  
  METHODS
  multicenter tertiary referral academic and clinical practice.
  
  
  METHODS
  fifty-three eyes of 53 consecutive subjects undergoing ECP-plus who had uncontrolled intraocular pressure (IOP) despite prior glaucoma surgeries and maximally tolerated medical therapy.
  
  
  METHODS
  retrospective analysis of clinical data after ECP-plus and pars plana vitrectomy.
  
  
  METHODS
  primary outcome was IOP at 6 and 12 months. Secondary outcomes were number of glaucoma medications and postoperative complications.
  
  
  RESULTS
  Diagnoses were primary open-angle glaucoma (32%), chronic angle-closure glaucoma (26%), and secondary open-angle glaucoma (OAG, 42%); 50/53 of subjects had 6 months' and 28/53 had 12 months' follow-up data. Preoperative IOP was 27.9±7.5 mm Hg (mean±SD). Postoperative IOP at 6 mo was 10.2±5.6 and at 12 mo was 10.7±5.2 lower than preoperative levels (all P<0.0001). Cumulative treatment success was 81% at 6 mo and 78% at 12 mo. Number of medications fell from 3.4±1.2 pretreatment to 0.8±1.0 at 1 to 6 mo and 0.7±1.2 at 12 mo postoperatively (all P<0.0001). Complications in the initial postoperative period (<3 mo) were hypotony (3/53, 6%), fibrinous uveitis (2/53, 4%), and cystoid macular edema without hypotony (CME; 4/53, 6%). Complications beyond 6 mo occurred in 8/50 (16%) subjects as hypotony (4/50, 8%), choroidal detachment (4/50, 3 with IOP<5 and 1 with IOP≥5; 8%), CME without hypotony (3/50, 6%), and failed corneal graft (1/50, 2%).
  
  
  CONCLUSIONS
  The mean IOP was lowered by at least 61% after ECP-plus and IOP lowering was sustained over the follow-up period. Fewer glaucoma medications were needed. Complication rates were comparable with or slightly higher than anterior endoscopic cyclophotocoagulation and acceptable given the refractory nature of disease being treated.
authors.affiliation: *Doheny Eye Institute †Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles (UCLA) ∥Department of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA ‡Ophthalmic Consultants of Connecticut, Fairfield, CT §Retinal Consultants, Little Silver, NJ.
authors.forename: James C H
authors.initials: JC
authors.lastname: Tan
authors.forename: Brian A
authors.initials: BA
authors.lastname: Francis
authors.forename: Robert
authors.initials: R
authors.lastname: Noecker
authors.forename: Martin
authors.initials: M
authors.lastname: Uram
authors.forename: Laurie
authors.initials: L
authors.lastname: Dustin
authors.forename: Vikas
authors.initials: V
authors.lastname: Chopra
mesh_terms: D000328:Adult; D000368:Aged; D002924:Ciliary Body / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D016896:Treatment Outcome