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Is endocylophotocoagulation (ECP) effective after failed glaucoma drainage device (GDD) surgery? The Malaysian experience

Purpose: To investigate the efficacy, survival time and safety profile of endoscopic cyclophotocoagulation (ECP) in patients with failed primary glaucoma drainage device (GDD). Material and methods: A retrospective case review of ten patients with primary GDD implantation who underwent ECP from July 2013 to April 2018. Ten eyes of 10 patients were included. Indication of ECP was failure to achieve target IOP with maximal tolerated medical therapy despite the GDD implantation. ECP were performed by a single surgeon over at least 270 degrees and the subjects were followed up to 1 year. Main outcome measures were mean reduction in IOP and anti-glaucoma medications at 1, 3, 6 and 12 months. The visual acuity and complications were also documented. Results: Mean IOP at baseline, 1, 3, 6 and 12 months were 17.7 + 3.74 mmHg, 18.1 + 8.1 mmHg, 18.1 + 6.1 mmHg, 16.5 + 5.9 mmHg, and 15.2 + 4.8 mmHg respectively. Although the IOP post ECP was in the downwards trend, it was not statistically significant (p=0.916). Mean difference in number of anti-glaucoma medications were 1.40, 1.44, 1.38, and 1.5 at baseline, 1, 3, 6 and 12 months respectively, which was statistically significant up to 6 months (p=0.036). One patient required repeat ECP due to uncontrolled high IOP and another had recurrent rhegmatogenous retinal detachment. No other complications encountered. Conclusion: ECP is a useful and safe surgery in managing refractory glaucoma with in-adequate IOP control post primary GDD implantation. Conflict of Interest: There is no conflicting relationship exists for any author.