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Omar S. Faridi, Michael J. Siegel, Chirag K. Gupta, Joseph C. Neilitz, Matthew E. Citron, Marc J. Siegel, Les I. Siegel; The Long-term Efficacy Of Combined Endoscopic Cyclophotocoagulation (ECP) And Phacoemulsification In The Treatment Of Mild-moderate Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2633.
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To evaluate the long-term efficacy of combined endoscopic cyclophotocoagulation (ECP) and phacoemulsification in the treatment of mild-moderate glaucoma.
Retrospective non-comparative non-industry sponsored interventional case series at one center with procedures performed by three glaucoma trained surgeons from 2004-2007. Patients were excluded if they had severe glaucoma or had prior phacoemulsification, cyclodestructive, filtering, or tube-shunt procedures. Utilizing IOP, glaucoma medication use, and complications as main outcome measures, evaluation was performed from baseline up to 66 months. Bonferroni’s adjustment was made for the multiple comparisons performed to baseline IOP.
The mean baseline IOP in 187 eyes of 111 patients was 17.69 ± 0.35 (SE) mmHg (range 8.0-45.00; median 17.00), 15.18 ± 0.43 at month 12 (n=157; P <0.0001), 15.06 ± 0.32 at month 24 (n=157; P <0.0001), 14.81 ± 0.29 at month 36 (n=132; P <0.0001), 14.94 ± 0.41 at month 48 (n=52; P=0.012), 13.93 ± 0.6 at month 54 (n=30; P=0.005), 14.87 ± 0.52 at month 60 (n=15; P=1.000). The baseline mean number of glaucoma medications was 0.87 ± 0.04 (SE) (median 1.00; range 0-3) and 0.33 ± 0.17 at month 60. The mean IOP significantly changes with an average reduction of 14.57% ± 1.78. The likelihood of sustained IOP control without the use of glaucoma medications is significant at every time point showing that patients were 7.78 times as likely to have no glaucoma medications at 12 months, 8.07 at 24 months, 8.45 at 36 months, 21.37 at 48 months, and 65.42 times more likely to be without glaucoma medications at 60 months (all P<0.0001). Subsequent secondary glaucoma procedures were performed in 9 patients, including 7 selective laser trabeculoplasties, 2 laser peripheral iridotomies, 2 trabeculectomies, 1 tube shunt, and 1 diode laser. Cystoid macular edema occurred in 3 patients, successfully treated in 2 patients with one lost to follow-up. One patient required a penetrating keratoplasty.
The use of ECP and phacoemulsification in mild-moderate glaucoma safely and effectively lowers IOP and the dependence on glaucoma medications up to five years. This combination procedure may in turn lead to less financial burden and adverse effects associated with glaucoma drops.
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