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Aman Shukairy, Bret A. Hughes, Mark S. Juzych; Endoscopic Diode Laser Cyclophotocoagulation in Conjunction with Cataract Surgery in the Management of Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2632.
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To evaluate and report in eyes with primary open angle glaucoma (POAG) and visually significant cataracts that underwent diode laser endocyclophotocoagulation (ECP) with cataract extraction versus cataract extraction (CE) alone the clinical course, complications, and outcomes including intraocular pressure (IOP), visual acuity, and number of glaucoma medications used.
A retrospective study of 26 subjects at the John D. Dingell Veterans Medical Center was performed. Subjects were divided into 2 groups based on whether they underwent ECP in conjunction with CE versus CE alone. Demographic information, clinical settings, pertinent operative and preoperative data, treatment methods and outcomes were recorded.
Twenty-six patients met inclusion criteria; 16 (62%) underwent CE with ECP and 10 (38%) underwent CE alone. The mean age of patients was 75.5 years. All 26 patients had a diagnosis of POAG. All eyes were treated with postoperative prednisolone acetate, moxifloxacin, and ketorolac drops. All 16 patients treated with ECP received 180 degrees of treatment, with an average of 33 treatment spots placed. In the ECP group, IOP improved from 15.3 (mean, pre-op) to 13.8 (mean, final, p=0.19) and Tmax improved from 22.9 (mean, pre-op) to 17.8 (mean, postop, p=<0.0001). In the CE group, IOP remained stable at 12.9 (mean, pre-op) to 13.3 (mean, final, p=0.73), and Tmax improved from 20.1 (mean, pre-op) to 19.2 (mean, postop, p=0.34). Visual acuity improved from 20/60 (mean, pre-op) to 20/40 (mean, final, p=0.003) in the ECP group, and improved from 20/100 (mean, pre-op) to 20/30 (mean, final, p=<0.0001) in eyes that received CE alone. In the ECP group, number of IOP-lowering medications was reduced from 2.8 (mean, preop) to 1.6 (mean, postop, p=0.02); in the CE only group, number of glaucoma medications remained stable at 1.6 (mean, preop) to 1.9 (mean, postop, p=0.59). Mean follow up for both groups was 5 months.
Ciliary destruction procedures traditionally have been reserved for more refractory cases of glaucoma and in eyes with poor visual potential, however ECP is being increasingly used in conjunction with CE, and with fewer postoperative complications than traditional transceral cyclophotocoagulation. In our study, patients who had ECP performed at the time of cataract surgery had a greater reduction in mean IOP versus those who had CE alone, as well as a significant reduction in Tmax postoperatively and in number of glaucoma medications over time while eyes that underwent CE alone did not.
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