Long-term Surgical Outcomes of Phacoemulsification with Endoscopic Cyclophotocoagulation vs Phacoemulsification with Trabeculectomy and Mitomycin in Cataract and Glaucoma Patients

Abstract

Purpose To evaluate the long-term surgical outcomes of endoscopic cyclophotocoagulation (ECP) after four years follow-up in cataract and glaucoma patients that needed combined phacoemulsification and ECP (phaco-ECP) in comparison to combined phacoemulsification with trabeculectomy (phaco-trabeculectomy) with mitomycin C (MMC). Patients and Methods Retrospective case–control study of 34 patients (34 eyes) with glaucoma who underwent phaco-ECP compared with phaco-trabeculectomy in tertiary eye specialist hospital in Saudi Arabia from 2010 to 2012. Participants were enrolled in two groups; ECP and trabeculectomy with MMC when combined with phacoemulsification. Success is defined as complete success when the IOP ≤21 mmHg without medication, qualified success when the IOP ≤21 mmHg with aid of topical medication. Results Mean IOP decreased from 25.76 SD ±8.227 to 15.24 SD ±7.049 at last visit in phaco-trabeculectomy group and from 21.47 SD ±4.215 to 12.88 SD ±3.480 in phaco-ECP group. Mean medication use reduced from 2.89 SD ±0.3 preoperatively to 1.50 SD ±1.1 postoperatively ( P <0.001) in phaco-trabeculectomy group. It reduced in phaco-ECP group from 2.24 SD ±0.8 preoperatively to 2.00 SD ±0.9 postoperatively, 35.3% of phaco-trabeculectomy group developed vision-threatening complications while 0% in phaco-ECP group ( P <0.001), 29.4% in phaco-trabeculectomy group required second surgical intervention compared to 17.6% in phaco-ECP group. In phaco-trabeculectomy group, 29.4% reached complete success, meanwhile in phaco-ECP group, 64.7% reached qualified success ( P =0.026). Conclusion ECP illustrates significant reduction of IOP and less postoperative complications if associated with phacoemulsification. Furthermore, it is safe and effective as a primary procedure alternative to combined cataract and trabeculectomy surgery for glaucoma patients having cataract and requiring surgical intervention.

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

“…Even in the last visit, the ECP and phaco group maintained favorable results (MD -1.49 mm Hg; 95% CI -2.29 to -0.68; I²=29%; Figure 5 ). This consistent trend aligns with findings in the literature, suggesting a long-term beneficial effect of the combined approach [ 13 , 21 , 25 - 27 ]. The modulating properties of ECP on aqueous humor production may elucidate the enduring benefits of IOP reduction over time.…”

Endoscopic cyclophotocoagulation for glaucoma compared to alternative procedures –A Systematic review

“…Ten of the included studies[ 30 31 33 34 35 36 37 38 39 ] reported the success rate of ECP and non-ECP in treating refractory glaucoma. These values were reported based on the longest follow-up period.…”

“…All of the included studies[ 30 31 32 33 34 35 36 37 38 39 ] reported the mean postoperative reduction IOP and with standard deviation after ECP and non-ECP in treating refractory glaucoma. Table 5 is descriptive of the postoperative mean IOP reduction and the mean reduction in IOP lowering medications comparisons between the two groups.…”

“…Typically, the cost of the machines is considered to be a significant factor restricting the development of a surgical technique. Some studies[ 30 31 33 36 ] are not explicit about the laser equipment used but refer to the surgical process only. Expect just one study[ 28 ] which was set in KSA, all the other studies are set in the US and European countries, this could deflect the outcome analysis based on ethnic factors.…”