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E. J. Grieser, M. F. Smith, J. M. Doyle, J. Troupe; Combined Endocyclophotocoagulation and Cataract Extraction vs. Cataract Extraction Alone in the Management of Glaucoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):446.
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Both Endocyclophotocoagulation (ECP) combined with cataract extraction via phacoemulsification and cataract extraction via phaocemulsification (phaco) alone have been shown to reduce intraocular pressure in patients with glaucoma. However, to date, no controlled studies have been reported in peer reviewed publications comparing the efficacy of these two procedures.
A retrospective chart review of patients with glaucoma who underwent combined ECP/phaco or phaco alone. Inclusion criteria for the review were any patient with a diagnosis of glaucoma who received ECP/phaco between 11/06/2006 and 07/08/2008. Patients with a diagnosis of glaucoma who underwent phaco alone between 11/01/05 and 10/31/06 were used as a historical control. Primary endpoint for this study was change in intraocular pressure (IOP) from the pre-operative visit and the 1-day, 1-week, 1-month, and 5 months post-operative visits. A secondary endpoint was the number of glaucoma medications used before and after surgery in both groups.
115 eyes of 95 patients diagnosed with glaucoma received a surgical procedure: 54 eyes - ECP/phaco, 60 eyes - phaco alone. The mean initial preoperative intraocular pressure was 16.7 +/- 5.0 mmHg in the ECP/phaco and 15.0 +/- 4.7 mmHg in the phaco alone group. At 5 months the average IOP had decreased to 15.0 +/- 4.4 mmHg in the ECP/phaco group and 14.1 +/- 4.3 mmHg in the cataract extraction alone group. Although it would appear that the ECP/phaco group had a greater mean reduction in intraocular pressure, repeated measure analysis showed a statistically lower pressure in the phaco only group for the time interval measured (p<0.0001).The average number of glaucoma medications required prior to surgery was 2.6 +/- 1.3 in the ECP/phaco group and 2.2 +/- 1.3 in the phaco only group. At the 5 month post op visit the average number of glaucoma medications was 1.8 +/- 1.4 in the combined treatment group and 1.9 +/- 1.3 in the cataract extraction only group. This did not represent a statistically significantly greater reduction in medications between the two groups (p=0.0643).
While intraocular pressure dropped in both the ECP/phaco and the phaco only group, surprisingly the control group demonstrated a statistically significant lower intraocular pressure during each time point measured. ECP combined with cataract surgery failed to demonstrate a statistically significant improvement in reduction of intraocular pressure, nor number of anti-glaucoma medications required when compared with cataract surgery alone.
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