Neovascular glaucoma (NVG) often results in loss of vision and severe pain caused by rapid elevation of IOP. There are several treatment modalities for this disease depending on the stage/severity of disease and the underlying cause. Many of the standard treatments are moderately effective and can be technically difficult in NVG patients, and are associated with an array of severe complications.
Endoscopic Cyclophotocoagulation was first described in a small group of NVG patients in 1995 by Dr. Martin Uram.(1) Since then, larger studies have been performed suggesting that ECP can safely control IOP as compared with standard glaucoma treatments. Jorge Arroyo, et.al. published a case-matched comparison of vitrectomy, peripheral retinal endolaser, and ECP vs standard care in 2014. (2)
ECP is performed through a pars plana incision facilitating a 360° view of the ciliary processes. Laser energy is set at typical levels of 200-300 mw of power. A 180° treatment of the ciliary processes is usually adequate to control IOP without creating hypotony, however in a recent study by Jorge Arroyo, MD, MPH, et. al. (see below), 27 patients were treated with combined PPV and 360° of ECP and PRP (ECP plus).
NVG - ECP and Radial Optic Neurotomy
NVG - Pars Plana approach, opaque cornea, and an AC-IOL
NVG - First Human ECP (3,000 pixel scope)