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Editors Selection IGR 21-4
Surgical Treatment: Endo-cyclophotocoagulation in tube-shunted eyes
Comment by Robert Feldman on:
70103 Endoscopic cyclophotocoagulation versus second glaucoma drainage device after prior aqueous tube shunt surgery, Murakami Y; Akil H; Chahal J et al., Clinical and Experimental Ophthalmology, 2017; 45: 241-246
Murakami et al. report a retrospective comparative case series of eyes at one institution who had refractory glaucoma (excluding neovascular) despite a glaucoma drainage device (GDD). Eyes received either aggressive endocyclophotocoagulation or a second GDD. They found no significant difference between the groups in success defined as an IOP between five and 21 mm HG inclusive and a 20% reduction in IOP. It is important to note one surgeon performed the ECP while several performed the second GDD which adds to potential bias. Unfortunately, no post-hoc power calculations were done to give us an idea of likelihood of trends meaning anything which also limits the conclusions that can be drawn.
Although success rates trended toward better in the ECP group, the mean IOP and IOP reduction was greater in the GDD2 group. Different failure criteria appear in various places in the report and it is difficult to reach any conclusions other than no significant difference was found.
What we can take away is that both procedures may be efficacious in non neovascular glaucoma refractory to a single GDD. We await the results of the ASSIST study for a randomized trial of cyclophotocoagulation to a second GDD.
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