Clinical aspects of the application of endoscopic laser cyclodestruction

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Abstract

BACKGROUND: Glaucoma remains one of the leading causes of irreversible vision loss worldwide, due to the steadily increasing incidence with age. In recent years, minimally invasive glaucoma surgery combined with cataract extraction has gained significant popularity as an alternative to traditional filtering surgeries. Among the methods of hypotensive action included in the minimally invasive glaucoma surgery concept, endoscopic laser cyclodestruction plays a special role, allowing for effective reduction of aqueous humor production.

AIM: The aim of this study is to determine the optimal conditions for achieving maximum efficiency and safety of endoscopic laser cyclodestruction.

MATERIALS AND METHODS: The present study analyzed the results of 110 combined procedures (phacoemulsification and endoscopic laser cyclodestruction) performed in our clinic. The study included 110 patients (56 men and 54 women) aged from 56 to 89 years (mean age 73.7 years) diagnosed with stage I–IV glaucoma and initial complicated cataract. All patients underwent anterior endoscopic laser cyclodestruction using the E2 videoendoscopic laser ophthalmic device (Endo Optiks Inc., USA) after phacoemulsification and intraocular lens implantation. Dynamic follow-up included visual acuity testing, perimetry, tonometry, instillation regimen assessment, anterior segment OCT, and registration of complications over 60 months.

RESULTS: The data analysis showed no hemorrhagic complications and significant inflammatory reactions in the vast majority of patients. The average dynamics of intraocular pressure reduction over 60 months was 24.6%, indicating the high efficacy of endoscopic laser cyclodestruction in intraocular pressure lowering and in stabilizing the condition in glaucoma patients.

CONCLUSIONS: Endoscopic laser cyclodestruction demonstrates high efficacy and safety, with virtually no contraindications, except in cases of technical difficulties. The optimal efficiency of the procedure is achieved by destructing the ciliary body processes over 180–200°, significantly reducing intraocular pressure and decreasing dependence on hypotensive therapy.

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About the authors

Alexei N. Kulikov

Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru
ORCID iD: 0000-0002-5274-6993
SPIN-code: 6440-7706

MD, Dr. Sci. (Medicine), Professor, Colonel of the Medical Service

Russian Federation, 6G Akademika Lebedeva st., Saint Petersburg, 194044

Vyacheslav Yu. Skvortsov

Kirov Military Medical Academy

Email: docuran@gmail.com
ORCID iD: 0000-0002-1345-9537
SPIN-code: 6417-1899

MD, Cand. Sci. (Medicine)

Russian Federation, 6G Akademika Lebedeva st., Saint Petersburg, 194044

Dmitrii V. Tulin

Kirov Military Medical Academy

Author for correspondence.
Email: d.v.tulin@gmail.com
ORCID iD: 0000-0003-3485-8227
SPIN-code: 8336-7272

MD

Russian Federation, 6G Akademika Lebedeva st., Saint Petersburg, 194044

References

  1. Kapetanakis VV, Chan MP, Foster PJ, et al. Global variations and time trends in the prevalence of primary open angle glaucoma (POAG): a systematic review and meta-analysis. Br J Ophthalmol. 2016;100(1):86–93. doi: 10.1136/bjophthalmol-2015-307223
  2. Alekseev BN, Ermolaev AP. Trabeculotomy ab interno combined with extracapsular cataract extraction and IOL implantation. Russian Annals of Ophthalmology. 2003;119(4):7–10. EDN: TUDILN
  3. Libman ES, Chumaeva EA. Epidemiological characteristics of glaucoma. In: Collection of articles of the IV International Conference: Glaucoma: theories, trends, technologies. Moscow; 2006. P. 203–213. (In Russ.)
  4. Bourne RRA, Flaxman SR, Braithwaite T, et al. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(9):e888–e897. doi: 10.1016/S2214-109X(17)30293-0
  5. Lochhead J, Casson RJ, Salmon JF. Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy. Br J Ophthalmol. 2003;87(7):850–852. doi: 10.1136/bjo.87.7.850
  6. Guedes RAP, Guedes VMP, Gomes CEM, Chaoubah A. Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity. Medicine (Baltimore). 2016;95(52):e5745. doi: 10.1097/MD.0000000000005745
  7. Agrawal P, Bradshaw SE. Systematic literature review of clinical and economic outcomes of micro-invasive glaucoma surgery (MIGS) in primary open-angle glaucoma. Ophthalmol Ther. 2018;7(1):49–73. doi: 10.1007/s40123-018-0131-0
  8. Francis BA, Berke SJ, Dustin L, Noecker R. Endoscopic cyclophotocoagulation combined with phacoemulsification versus phacoemulsification alone in medically controlled glaucoma. J Cataract Refract Surg. 2014;40(8):1313–1321. doi: 10.1016/j.jcrs.2014.04.031
  9. Siegel MJ, Boling WS, Faridi OS, et al. Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma. Clin Exp Ophthalmol. 2015;43(6):531–539. doi: 10.1111/ceo.12518
  10. Francis BA, Kwon J, Fellman R, et al. Endoscopic ophthalmic surgery of the anterior segment. Surv Ophthalmol. 2014;59(2): 217–231. doi: 10.1016/j.survophthal.2013.03.010
  11. Walland MJ. Diode laser cyclophotocoagulation: Longer term follow up of a standardized treatment protocol. Clin Exp Ophthalmol. 2000;28(4):263–267. doi: 10.1046/j.1442-9071.2000.00320.x
  12. Boiko EV, Kulikov AN, Skvortsov VYu. Evaluating the effectiveness and safety of diode laser trans-scleral thermotherapy of the ciliary body as a treatment for refractory glaucoma. Russian Annals of Ophthalmology. 2014;130(5):64–66. EDN TGLRSN
  13. Francis BA, Kawji A, Vo NT, et al. Endoscopic cyclophotocoagulation (ECP) in the management of uncontrolled glaucoma with prior aqueous tube shunt. J Glaucoma. 2011;20(8):523–527. doi: 10.1097/IJG.0b013e3181f46337
  14. Skvortsov VYu, Tulin DV, Mirgorodskaya OE. Morphological changes and postoperative inflammatory response after endoscopic laser cyclodestruction in various modes (experimental study). Modern Technologies in Ophthalmology. 2022;(6):194–201. EDN ZCUSCB. doi: 10.25276/2312-4911-2022–6-194-201
  15. Boiko EV, Kulikov AN, Skvortsov VYu. Comparative evaluation of diode laser thermotherapy and laser coagulation as methods of cyclodestruction (experimental study). Practical Medicine. 2012;(1):175–179. EDN: PCAHEL
  16. Pantcheva MB, Kahook MY, Schuman JS, Noecker RJ. Comparison of acute structural and histopathological changes in human autopsy eyes after endoscopic cyclophotocoagulation and trans-scleral cyclophotocoagulation. Br J Ophthalmol. 2007;91(2):248–252. doi: 10.1136/bjo.2006.103580
  17. Uram M. Combined phacoemulsification, endoscopic ciliary process photocoagulation, and intraocular lens implantation in glaucoma management. Ophthalmic Surg. 1995;26(4):346–352.
  18. Roberts SJ, Mulvahill M, SooHoo JR, et al. Efficacy of combined cataract extraction and endoscopic cyclophotocoagulation for the reduction of intraocular pressure and medication burden. Int J Ophthalmol. 2016;9(5):693–698. doi: 10.18240/ijo.2016.05.09
  19. Seibold LK, SooHoo JR, Kahook MY. Endoscopic cyclophotocoagulation. Middle East Afr J Ophthalmol. 2015;22(1):18–24. doi: 10.4103/0974-9233.148344
  20. Kaplowitz K, Kuei A, Klenofsky B, et al. The use of endoscopic cyclophotocoagulation for moderate to advanced glaucoma. Acta Ophthalmol. 2015;93(5):395–401. doi: 10.1111/aos.12529
  21. Gedde SJ, Schiffman JC, Feuer WJ, et al. Tube versus Trabeculectomy Study Group. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153(5):789–803. doi: 10.1016/j.ajo.2011.10.026
  22. Ishida K. Update on results and complications of cyclophotocoagulation. Curr Opin Ophthalmol. 2013;24(2):102–110. doi: 10.1097/ICU.0b013e32835d9335
  23. Konstantinov AS, Kulikov AN, Skvortsov VYu. Method of objective assessment of the severity of postoperative inflammatory response in phacoemulsification of cataract, including in combination with endoscopic laser cyclodestruction. Izvestia of the Russian Military Medical Academy. 2020;39(S1–1):209–212. EDN: DCKHGN.
  24. Clement CI, Kampougeris G, Ahmed F, et al. Combining phacoemulsification with endoscopic cyclophotocoagulation to manage cataract and glaucoma. Clin Exp Ophthalmol. 2013;41(6):546–551. doi: 10.1111/ceo.12051

Supplementary files

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2. Fig. 1. Fibrinoid network in the pupil lumen on the first day after combined operation — phacoemulsification + endoscopic laser cyclodestruction

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3. Fig. 2. Typical example of native (not processed) images of inflammatory elements in the anterior chamber fluid at optical coherence tomography of the anterior segment: a — after standard phacoemulsification (PEC); b — after PEC + endoscopic laser cyclodestruction (ELCD) without vaporization bioeffect; c — after PEC + ELCD with vaporization bioeffect

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4. Fig. 3. Stages of image analysis obtained by anterior segment optical coherence tomography: a — image cropping (Adobe Illustrator CC 2018); b — adjustment of upper and lower threshold values for the image (60–255); c — counting of studied objects (ImageJ, National Institutes of Health, USA)

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5. Fig. 4. Dynamics of intraocular pressure in the whole study group of patients

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