Long term Intraocular Pressure Control Using Combined Endoscopic Cyclophotocoagulation (ECP) And Phacoemulsification in the Treatment of Mild to Moderate Glaucoma - 5 Year Results

Abstract

Purpose: The purpose of this study is to evaluate the long-term efficacy of Phacoemulsification combined with Endoscopic Cyclophotocoagulation in the treatment of mild-moderate glaucoma.

Methods: This was a retrospective, case-controlled, non-industry sponsored interventional study at one center from 2004-2012. Inclusion criteria included mild to moderate glaucoma of any type with or without medical therapy. Main outcome measures included intraocular pressure, glaucoma medication use and complications. Patients were excluded if they had severe glaucoma, prior phacoemulsification, cyclodestructive, filtering, or tube-shunt procedures. Evaluation was performed from baseline up to 66 months.

Results: The Mean baseline IOP in 261 eyes of 163 patients was 17.27 mmHg (± 0.29 SE). The mean IOP was significantly reduced at every time point from baseline to 66 months with the average IOP at month 66 (n=47) being 13.63 mmHg (± 0.41 SE). At baseline the mean number of glaucoma medications was 1.27 (± 0.35 SE) (median 1.00; range 1-4). After Phaco/ECP the number of medications to control IOP was significantly reduced at every time point from baseline to 66 months with the mean number of medications at 66 months (n=47) being 0.19 (± 0.05 SE). The number of eyes that had IOP spikes ≥10 mmHg within the first postoperative month was minimal. 21 eyes (8.3%) had 1 IOP spike, and 5 eyes (1.7%) had 2 IOP spikes.

Conclusions: This study shows a significant reduction in IOP from baseline up to 66 months with an average reduction in IOP of 21.1%. After undergoing ECP at the time of cataract surgery, patients on topical medication are 10.5 times more likely to be off of medications at 66 months from when compared to baseline. At 66 months, 60% of patients were able to maintain or decrease IOP without any increase in medication use and 50% of patients were able to achieve a minimum of 10% reduction of IOP with no increase in utilization of IOP lower medications. Although this study has limitations due to its retrospective and non-comparative nature, these results show effective control of IOP with less dependence on topical medications. Thus, ECP is a safe and simple procedure to use at the time of cataract surgery for the long-term control of mild-moderate glaucoma.

Keywords: 568 intraocular pressure • 578 laser • 445 cataract