Endoscopic Cyclophotocoagulation Combined with Phacoemulsification Increases Risk of Persistent Anterior Uveitis Compared to Phacoemulsification Surgery Alone

Abstract

Purpose To evaluate if the addition of endoscopic cyclophotocoagulation (ECP) to uncomplicated phacoemulsification cataract extraction increases the risk of persistent anterior uveitis (PAU) compared to phacoemulsification alone. Patients and Methods Retrospective analysis of patients who had either phacoemulsification alone or combined with endoscopic cyclophotocoagulation from January 1, 2014 to December 31, 2017. Visual acuity, intraocular pressure, presence of anterior chamber cells, and steroid usage were analyzed pre- and post-operatively. Patient eyes with a history of uveitis, autoimmune disease, complicated cataract surgery, combined surgery other than ECP, and less than 3 months of follow-up were excluded. Results This study consisted of 4423 eyes from 2903 patients, meeting the inclusion criteria (phacoemulsification only group n=4242 and phacoemulsification/ECP group n=181 eyes). PAU developed in 14.9% in the phacoemulsification with ECP group compared to 1.7% who had phacoemulsification alone. White patients had a 17.9 (95% CI: 7.8–41.1, p<0.0001) increased odds of developing persistent anterior uveitis with a combined procedure compared to phacoemulsification only, while Non-white patients had a 5.8 (95% CI: 2.8–12.1, p<0.0001) increased odds. Despite the higher odds ratio in White patients, this group had a significantly lower rate of PAU compared to Non-white patients after phacoemulsification/ECP. Conclusion The addition of endoscopic cyclophotocoagulation to phacoemulsification significantly increases the risk of developing PAU in the post-operative period compared to phacoemulsification alone.

Inequities and Research Gaps in Ophthalmology

“…Women were less likely to undergo certain ophthalmic surgical procedures. 55,56 In contrast, 11 studies found no association between sex and/or gender and ophthalmic conditions, 30,34,[57][58][59][60] follow-up adherence, 23,[27][28][29] or access to eye care. 37 Further findings can be found in the eTable in the Supplement.…”

Combined Endoscopic Cyclophotocoagulation and Phacoemulsification Versus Phacoemulsification Alone in the Glaucoma Treatment: A Systematic Review and Meta-Analysis

“…Next, six articles were excluded as per our exclusion criteria. Finally, nine studies were included in this review, one randomized controlled trial (RCT) [15], one prospective non-randomized cohort [11], and seven retrospective cohorts [16][17][18][19][20][21][22].…”

“…Sheybani et al proposed that patients undergoing ECP and phaco may experience a marginally more significant degree of myopia and increased variability in postoperative refraction, potentially attributed to complications specific to the combined procedure [ 17 ]. Notably, severe glaucoma patients, often associated with a guarded prognosis, might contribute to this divergence [ 13 , 19 , 21 ]. Corneal edema induced by intraocular laser in phaco-ECP is a factor that may reduce visual acuity compared to phaco alone, stemming from increased intraoperative corneal distortion and heightened postoperative inflammation [ 23 , 24 ].…”

“…We believed that the observed outcome was probably due to a combination of increased laser energy administered to the eye and the inflammatory damage to ciliary processes, which in turn led to a heightened inflammatory reaction [ 10 , 20 ]. Despite phaco-ECP having a higher number of complications, in general, these were easily treated and nearly all fully resolved with medical and just seven cases required further operative intervention in this meta-analysis [ 13 , 19 ].…”

“…Many studies included in this analysis reported follow-up periods ≥ 3 months. However, long-term outcomes (≥ 12 months) beyond the follow-up period were assessed in just a few studies [ 9 , 17 , 19 ]. It is crucial to assess the long-term stability of surgical effects.…”