Abstract
Purpose: :
To determine the efficacy and safety of performing combined phacoemulsification and endoscopic cyclodiode photocoagulation (ECP) in patients with glaucoma who require cataract surgery.
Methods: :
The medical records of patients that had undergone combined phacoemulsification and ECP between 2001 and 2009 at the Western Eye Hospital, London were retrospectively reviewed. In all cases, treatment involved phacoemulsification with intraocular lens inserted "in the bag" via a temporal clear corneal incision followed by 270 - 360 degree ECP (Endo Optiks, NJ, USA) treatment of the ciliary processes. Patients were excluded from the study if they were lost to follow-up less than 12 months following surgery. Visual acuity, IOP and number of medications were recorded before surgery and at 3-months, 6-months, 9-months and 12-months following surgery. Early and late post-operative complications were also recorded.
Results: :
Forty-two eyes of 38 patients meet the inclusion criteria. Mean age at the time of surgery was 72.62 ± 10.14 years. Fifty-seven percent were male. Types of glaucoma included: primary open angle (73.8%), chronic angle closure (11.9%), uveitic (4.8%), angle recession (2.4%), iridocorneal endothelial syndrome (2.4%), exfoliative (2.4%) and normal tension (2.4%). Pre-operatively, LogMAR visual acuity was 0.84 ± 0.69 with mean IOP 22.36 ± 6.52 mmHg on 2.83 ± 0.98 IOP lowering medications. At 3-months following surgery, IOP had reduced to 15.6 ± 2.3 mmHg and was maintained until 12-months following surgery (15.90 ± 2.28mmHg). By the end of the study period, visual acuity had improved to LogMAR 0.37 ± 0.27 and the number of IOP lowering medications had reduced to 1.60 ± 0.89. Complications included fibrinous uveitis (7.2%), corneal decompensation (4.8%), posterior vitreous detachment (4.8%) and surgically induced astgmatism (2.4%). There were no cases of hypotony. Two patients (4.8%) required repeat ECP to control IOP.
Conclusions: :
This study suggests combined phacoemulsification and ECP is both safe and effective in patients with glaucoma and cataract. It provides effective IOP lowering and reduced dependence on IOP lowering medications whilst addressing the visual disability caused by cataract in a single surgical treatment. Prospective and longer-term studies are needed to help better understand the benefits and complications of this treatment.
Keywords: ciliary processes • cataract • laser