NTERIOR SEGMENT GLAUCOMA TREATMENT
New Treatment Alternative
Can CEaP Work as a Complete Treatment for Neovascular Glaucoma? by Olawale Salami
F
or decades, ophthalmologists have been working on finding the best treatments for neovascular glaucoma (NVG). A refractory form of glaucoma, NVG is characterized by vessel proliferation involving the iris and the anterior chamber angle, with eventual angle closure and intractable elevation of intraocular pressure (IOP). It is commonly associated with ischemic retinal conditions, such as proliferative diabetic retinopathy (PDR), branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and carotid artery occlusion. Sustained IOP reduction and elimination of neovascular proliferation are critical treatment goals. However, few available treatments can meet both targets simultaneously. Current treatment options for NVG include pan-retinal photocoagulation (PRP), filtering surgery, anterior retinal cryotherapy (ARC), anti-vascular endothelial growth factor (VEGF) injections, cyclocryotherapy (CCT) and transscleral cyclophotocoagulation (TSCPC). Some procedures such as CCT and TSCPC can produce sustained
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IOP reduction in NVG by reducing aqueous humor formation. However, their associated complications, such as marked inflammation, hypotony and phthisis, limit their clinical utility in many patient populations.
A patient-friendly treatment alternative for NVG Endoscopic cyclophotocoagulation (ECP) utilizes a high precision laser beam, which can be delivered to the target tissue under direct visualization at appropriate energy levels. The high accuracy of this technique helps avoid damage and inflammation in surrounding tissue.1 Therefore, combining endoscopic cyclophotocoagulation and pars plana ablation as one single procedure (ECPplus) could be an effective and safe treatment toward the relief of refractory glaucoma. So, does this work in patients with NVG? To answer this question, Dr. Chia-Jen Chang and colleagues at the Taichung Veterans General Hospital in Taiwan, developed a combination therapy, known as
| Sept/Oct 2020
Combined Endoscope assisted Procedures (CEaP), which involves endoscopic cyclophotocoagulation and pars plana ablation (ECP-plus), combined with endoscopic pan-retinal photocoagulation. Their findings — summarized in a paper titled Combined Endoscope assisted Procedures (CEaP) as a Complete Treatment for Neovascular Glaucoma — were published recently.2 In a retrospective and noncomparative interventional case series, the team analyzed data from patients who were diagnosed with NVG, and whose treatment had failed with previous anti-glaucoma drugs, PRP and anti-VEGF treatment. Diagnosis of NVG was confirmed if the patient had vessel growth at the iris and an anterior chamber angle with an IOP > 21 mmHg. Failure following previous treatment was defined as the presentation of neovascularization at the iris and the anterior chamber angle, along with an IOP > 21 mmHg after treatment of more than 3 months. Overall, 25 eyes from 23 patients were included over a 24-month period.
