Endocyclophotocoagulation by pars plana approach in the management of refractory glaucoma with prior phacoemulsification and Ahmed gonioimplantation in a dog.

PURPOSE: To describe successful intraocular pressure control of refractory glaucoma and vision preservation with an endocyclophotocoagulation (ECP) procedure by pars plana approach.

ANIMAL STUDIED: An 8-year-old, female-spayed, mixed-breed goniodysgenic dog with glaucoma following phacoemulsification with intraocular lens placement (IOL) refractory to maximized medical therapy and Ahmed gonioimplantation in both eyes (OU).

PROCEDURES: For the first glaucoma interventional surgery, bilateral goniovalve implantation was performed following cataract surgery. A goniovalve was implanted in the left eye (OS) 2-days post-phacoemulsification, and 14-days post-phacoemulsification in the right eye (OD). Short-term intraocular pressure (IOP) control was achieved. However, glaucoma recurred 41-days post-phacoemulsification OU, and an endocyclophotocoagulation by pars plana approach was performed OU to treat 300° of the ciliary body with a 23-gauge argon laser endoscope.

RESULTS

Th ECP pars plana approach was successful in obtaining IOP-control and vision preservation during a 15-month follow-up period. No intraoperative complications were encountered. Short-term postoperative complications included intraocular inflammation with fibrin and postoperative ocular hypertension. Intraocular pressure-control and vision preservation were maintained at the last follow-up examination, 15 months postoperative pars plana ECP.

CONCLUSION

Endocyclophotocoagulation by pars plana approach achieved long-term (>1 year) IOP-control, preserved vision, and reduced the number of anti-glaucoma medications following failure of previous Ahmed gonioimplantation for uncontrolled glaucoma. This is the first case report of an endocyclophotocoagulation procedure by a pars plana approach for uncontrolled glaucoma following Ahmed gonioplantation. With the appropriate skill set, this novel surgical approach can be considered as a surgical intervention for glaucoma in canine patients.