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Carter N. Kirk, Tyler Q. Kirk, Scott H. Kirk; Long-term Efficacy of Endoscopic Cyclophotocoagulation Combined with Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5928.
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Evaluate the long-term efficacy and safety of endoscopic cyclophotocoagulation with phacoemulsification (PE-ECP) in lowering intraocular pressure (IOP) and reducing glaucoma medication versus phacomulsification (PE) alone.
Retrospective review of 211 eyes: 110 PE-ECP and 101 PE. 360 degrees of ciliary processes were treated to an end-point of whitening and shrinking. Inclusion criteria: patients with at least three years of follow-up, no prior history of filtration surgery, and concurrent cataract and glaucoma or OHT diagnosis. Main outcome measures were visual acuity, IOP, glaucoma medications, and postoperative complications.
Mean final postoperative examinations were 53.2±10.9 months (PE-ECP) and 69.9±18.6 months (PE). PE-ECP patients went from preoperative mean ± SD IOP of 19.72±4.02 to 16.88±2.93 and 15.33±3.02 at three and five years (P<.0001), representing 14.2% and 22.3% reductions respectively. PE patients went from preoperative IOP 19.06±3.14 to 18.19 ± 3.80 (P=0.18) and 18.87 ± 3.91 (P=0.78) at three and five years, representing 4.7% and 1.0% reductions. Mean PE-ECP glaucoma medications went from a preoperative baseline of 1.6±1.0 to 1.0±1.1 at 3 years (P<.0001) and 1.1±1.2 at 5 years (P<.0001), representing 39.5 and 33.8% reductions. PE patients did not see a reduction in medications, from 1.1±1.0 preoperatively to 1.1±.9 (P=0.64) and 1.2±1.0 (P=0.15) at three and five years. Subgroup Kaplan-Meier analysis of OHT patients showed a survival of 0.77 and 0.75 respectively at 3 and 5 years in the PE-ECP group compared to 0.28 and 0.40 with PE. Mean logMAR best-corrected visual acuity (BCVA) improved from 0.47±0.29 preoperatively to 0.18±0.29 postoperatively (P<.0001) in PE-ECP eyes and from 0.48±0.29 to 0.21±0.3 (P<.0001) in PE eyes. PE-ECP patients had higher rates of postoperative complications: cystoid macular edema (P=0.12), transient corneal edema (P=0.001), and inflammatory fibrinoid reaction (P=0.04). There were no cases of hypotony (IOP <6mm Hg) or phthisis.
There was a significant, though transient, increase in initial postoperative complications in the PE-ECP group. Significant lowering of IOP and glaucoma medications was only found in the PE-ECP group at three and five years follow-up.
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