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Anita Arora, Ian Rodrigues, Saurabh Goyal; Phaco endoscopic cytophotocoagulation versus phaco external cyclodiode. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6169.
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To compare the efficacy and safety of two adjunctive laser procedures: endoscopic cyclophotocoagulation (ECP); and external cyclodiode laser (ECD), both combined with standard phacoemulsification cataract surgery.
Retrospective notes review of consecutive cases completed by a single surgeon at a single centre over a 15 month period. All patients had known glaucoma. Patients underwent standard phacoemulsification and IOL implantation followed by either ECP or ECD, as a single procedure. Diagnosis, medication history, baseline visual acuity (VA) and IOP were recorded. VA, IOP and number of glaucoma medications were recorded at day 1, 7, and 1, 3, 6 and 12 months post-op .
44 cases were performed during the defined time period. 28 had phako + ECP and 16 phako + ECD. Mean age was 76.73 years (SD ± 7.86). Mean follow-up was 207.3 ± 140.79 daysl. 88.7% were Caucasian, 4.5% Afro-Caribbean , 4.5% Indian and 2.3% South East Asian. 62.8% had primary open angle glaucoma, 18.5% primary angle closure glaucoma, 7% normal tension glaucoma and 7% pigmentary glaucoma. Pre-operative mean IOP was 22.07 ± 5.43 mmHg (22.39 ± 5.28 in ECP group; 21.5 ± 5.82 in ECD group). At 12 month follow-up, the IOP reduction was 7.66 ± 6.02 mmHg (p<0.0001). There was a reduction of 7.14 ± 4.93 mmHg in the ECP and 8.56 ± 7.65 in the ECD; there was no difference between the two groups (p=0.4579). 79.6% of patients had an IOP reduction >20% from baseline at last follow-up (82.1% in ECP group; 75% in the ECD group, p=0.57). Mean number of glaucoma medications in the two groups was 2.66 preoperatively. At 12 months, there was a significant reduction of 0.432 drops in the total number of glaucoma medications used (p=0.0063);there was no significant difference between the two groups. LogMAR equivalent visual acuity showed an improvement from 0.5581 ± 0.531 LogMAR to 0.3976 ± 0.4969 (p=0.0449).
This pilot study demonstrates that a significant reduction in IOP, number of glaucoma medications and improvement of vision is possible following cataract surgery with adjunctive ciliary body laser. This preliminary data suggests a possible role for the use of ECD as an adjunctive procedure to cataract surgery. This study supports the role for a prospective randomised controlled trial to demonstrate the efficacy of these two modalities of treatment in patients with co-existing cataract and glaucoma.
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