Oftalʹmologiâ (Oct 2024)
Endoscopic Laser Cyclodestruction: Clinical Aspects
Abstract
Glaucoma is one of the main causes of irreversible vision loss worldwide, its prevalence is increasing with age, reaching 10 % in individuals over 90 years old. Combined surgical treatment of cataract and glaucoma has proven to be safe and effective, reducing overall treatment costs. Minimally invasive glaucoma surgery (MIGS) combined with cataract surgery has become a popular alternative to traditional methods. One such intervention is endoscopic laser cyclodestruction (ELCD), aimed at reducing the production of aqueous humor.Objective: To evaluate the conditions for achieving maximum efficacy and safety of endoscopic laser cyclodestruction (ELCD) in the combined surgical treatment of glaucoma and cataract.Methods. A clinical study was conducted involving 110 patients (56 males and 54 females) with a mean age of 73.7 years, who underwent combined surgery (phacoemulsification + ELCD). Inclusion criteria were stages I-IV glaucoma and initial complicated cataract, while exclusion criteria included lens subluxation and presence of uveal processes or their consequences. ELCD was performed using the Endo Optiks Inc (USA) video-endoscopic ophthalmic laser device. Patients were evaluated preoperatively and followed up at 1, 3, 6, 9, 12, 18, 24, 36, 48, and 60 months postoperatively. The primary safety outcomes included the frequency of intraand postoperative complications, and efficacy outcomes were based on intraocular pressure (IOP) reduction.Results. No hemorrhagic complications were noted. An inflammatory reaction was observed in 18.2% cases, which was managed with subconjunctival injections of prourokinase. The frequency of postoperative IOP elevation correlated negatively with preoperative IOP levels. ELCD demonstrated a statistically significant reduction in IOP and medication burden, with a complete success rate of 52.7 % and a partial success rate of 90.3 %. The extent of cyclodestruction (180–360°) did not significantly affect IOP reduction outcomes.Conclusion. ELCD, performed as part of combined surgery for glaucoma and cataract, proved to be effective and safe, achieving significant IOP reduction and decreasing the need for antiglaucoma medications. Recommendations include avoiding vaporization effects during surgery and preferring patients with preoperative IOP above 27 mm Hg for optimal outcomes.
Keywords
