Endocyclophotocoagulation combined with phacoemulsification in surgically naive primary open-angle glaucoma: three-year results

Abstract

Objective To assess the safety and efficacy of endocyclophotocoagulation with phacoemulsification (phaco-ECP) in surgically naive, primary open-angle glaucoma (POAG). Methods A retrospective case series of patients undergoing phaco-ECP between 2007 and 2017 at a single centre in London, UK. The primary outcome was intraocular pressure (IOP). Secondary outcomes were visual acuity, visual field global indices, topical medications and surgical complications. Failure criteria were: (1) IOP > 21 mmHg or <20% reduction at two consecutive visits, (2) IOP <5 mmHg and (3) further IOP-lowering surgery. Results Eighty-three eyes from 83 patients were eligible. Pre-operatively, mean IOP (±SD) was 18.4 ± 5.2 mmHg. The mean number of topical agents (±SD) was 2.7 ± 0.9. Mean IOP (±SD) significantly reduced to 14.3 ± 4.7 at 1 year, 14.1 ± 4.0 at 2 years and 13.6 ± 3.7 at 3 years (p < 0.0001). Topical medications were significantly reduced to 1.3 ± 1.2 at 1 year, 1.7 ± 1.2 at 2 years and 1.8 ± 1.3 at 3 years (p < 0.0001). Annual IOP ‘survival’ was 70%, 54% and 45% at year 1, 2 and 3, respectively. Complications included uveitis (6%), macular oedema (2%), IOP spikes (1%) and corneal decompensation (1%) with no episodes of hypotony or retinal detachment. One patient underwent filtration surgery within 3 years (1%). Conclusion Phaco-ECP facilitates significant IOP lowering and reduction of medication burden in surgically naive POAG requiring cataract extraction. The procedure is relatively safe and without the use of implants and their associated risks.

Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study

“… 19 The nature of complications in both MIGS groups was similar to that of other studies as complications were minimal in severity and self-limiting. 29 , 30 The most striking observation was the high rate of active inflammation beyond POM1 in the ECP group compared to the KDB group. A previous study reported that up to 24% of ECP cases could be complicated by protracted post-op inflammation.…”

Minimally Invasive Glaucoma Surgery

“…109 Yap et al assessed the 3-year outcomes of phaco/ECP in POAG eyes. 110 They reported success rates of 70%, 54%, and 45% at years 1, 2, and 3, respectively, with statistically significant reductions in mean IOP and the number of topical medications from preoperative levels (P < 0.0001). Similarly, a study by Lindfield et al showed that phaco/ECP resulted in a statistically significant reduction in IOP at all postoperative time points up to 24 months, with a mean decrease of 7.1 mm Hg.…”

“…Previously used in refractory glaucoma, ECP is now utilized earlier in disease due to the advent of MIGS 109 . Yap et al assessed the 3-year outcomes of phaco/ECP in POAG eyes 110 . They reported success rates of 70%, 54%, and 45% at years 1, 2, and 3, respectively, with statistically significant reductions in mean IOP and the number of topical medications from preoperative levels ( P < 0.0001).…”

Zyklophotokoagulation – Vielfalt der Anwendungen

“…1 Medikament (− 0,9 ± 1,5) berichtet. 25 % der Patienten waren nach 3 Jahren medikamentenfrei und ohne weitere Operation [24]. Prospektive Vergleichsstudien mit abflussverbessernden minimalinvasiven Eingriffen wären hier wünschenswert.…”