Purpose:
Evaluate the long-term efficacy and safety of endoscopic cyclophotocoagulation with phacoemulsification (PE-ECP) in lowering intraocular pressure (IOP) and reducing glaucoma medication versus phacomulsification (PE) alone.
Methods:
Retrospective review of 211 eyes: 110 PE-ECP and 101 PE. 360 degrees of ciliary processes were treated to an end-point of whitening and shrinking. Inclusion criteria: patients with at least three years of follow-up, no prior history of filtration surgery, and concurrent cataract and glaucoma or OHT diagnosis. Main outcome measures were visual acuity, IOP, glaucoma medications, and postoperative complications.
Results:
Mean final postoperative examinations were 53.2±10.9 months (PE-ECP) and 69.9±18.6 months (PE). PE-ECP patients went from preoperative mean ± SD IOP of 19.72±4.02 to 16.88±2.93 and 15.33±3.02 at three and five years (P<.0001), representing 14.2% and 22.3% reductions respectively. PE patients went from preoperative IOP 19.06±3.14 to 18.19 ± 3.80 (P=0.18) and 18.87 ± 3.91 (P=0.78) at three and five years, representing 4.7% and 1.0% reductions. Mean PE-ECP glaucoma medications went from a preoperative baseline of 1.6±1.0 to 1.0±1.1 at 3 years (P<.0001) and 1.1±1.2 at 5 years (P<.0001), representing 39.5 and 33.8% reductions. PE patients did not see a reduction in medications, from 1.1±1.0 preoperatively to 1.1±.9 (P=0.64) and 1.2±1.0 (P=0.15) at three and five years. Subgroup Kaplan-Meier analysis of OHT patients showed a survival of 0.77 and 0.75 respectively at 3 and 5 years in the PE-ECP group compared to 0.28 and 0.40 with PE. Mean logMAR best-corrected visual acuity (BCVA) improved from 0.47±0.29 preoperatively to 0.18±0.29 postoperatively (P<.0001) in PE-ECP eyes and from 0.48±0.29 to 0.21±0.3 (P<.0001) in PE eyes. PE-ECP patients had higher rates of postoperative complications: cystoid macular edema (P=0.12), transient corneal edema (P=0.001), and inflammatory fibrinoid reaction (P=0.04). There were no cases of hypotony (IOP <6mm Hg) or phthisis.
Conclusions:
There was a significant, though transient, increase in initial postoperative complications in the PE-ECP group. Significant lowering of IOP and glaucoma medications was only found in the PE-ECP group at three and five years follow-up.
Keywords: intraocular pressure • ciliary processes • treatment outcomes of cataract surgery