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Combined Pars Plana Vitrectomy, Lensectomy and
Endocyclophotocoagulation in Diabetic Neovascular Glaucoma

Murat Karacorlu
Istanbul Turkey

To evaluate the efficacy of endocyclophotocoagulation during pars plana vitrectomy and lensectomy in patients with uncontrolled glaucoma secondary to the proliferative diabetic retinopathy. We compared preoperative and postoperative intraocular pressure (IOP) and visual acuity in 6 eyes of 6 patients aged between 24 and 70 years who had 180 to 240 degree of ciliary body endophotocoagulation with pars plana vitrectomy and lens extraction. Postoperative follow-up ranged form 12 to 24 months with a median of 15 months. Preoperative IOP on medical therapy for glaucoma ranged from 34 to 52 mmHg (median 38 mmHg). Postoperative IOP ranged from 16 to 26 mmHg (median 18mmHg) at 12 months. Twelve months after surgery, mean IOP reduction of 17 mmHg was statistically significant. One patient underwent an additional endocyclophotocoagulation 4 months after first procedure. No patients subsequetly underwent additional glaucoma procedure as filtration surgery with or without a glaucoma drainage tube implantation or cyclocryotherapy. Visual acuity improved in two patients. Complications encounted were transient hypotony (one eye) and hyphema (one eye). Endocyclophotocoagulation combined with cataract extraction and pars plana vitrectomy is a safe and effective treatment for uncontrolled neovascular glaucoma secondary to the proliferative diabetic retinopathy. The high success rate of intraocular pressure control and low incidence of phthisis or hypotony indicate that endocyclophotocoagulation may be more predictable treatment. Additional experience, both in patient number and follow-up duration is necessary to further assess the relative benefit and risk of this method.