Phacoemulsification and endocyclophotocoagulation in uncontrolled glaucoma: Three-year results

Abstract

Purpose: To describe the 3-year outcomes of combined cataract surgery and 360-degree endocyclophotocoagulation (ECP) in eyes with uncontrolled glaucoma and no previous glaucoma drainage surgery.

Setting: University Hospital Eye Department, Exeter, United Kingdom.

Design: Retrospective case series.

Methods: The study included patients who had combined cataract surgery and 360-degree ECP. The primary outcome measure was intraocular pressure (IOP) reduction at 3 years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 3 years and the complications of surgery. Failure was defined by 1 of 2 criteria: (1) IOP higher than 21 mm Hg or lower than 6 mm Hg or not reduced by 20% from baseline at the 1-, 2-, or 3-year timepoint and (2) further laser or other surgery to reduce IOP at any timepoint.

Results: The study comprised 84 patients (84 eyes). The mean IOP dropped from 18.7 mm Hg preoperatively to 13.3 mm Hg, 13.8 mm Hg, and 14.0 mm Hg at 1, 2, and 3 years postoperatively, respectively. By the 3-year timepoint, 58.3% had met the criteria for failure. The mean number of glaucoma medications was similar at 2.5 at 3 years postoperatively compared with 2.6 preoperatively. Nine patients (10.7%) had a significant complication, but all resolved without long-term sequelae.

Conclusions: At 3 years postoperatively, combined cataract surgery and 360-degree ECP achieved a modest but significant drop in IOP in phakic patients with uncontrolled glaucoma and no previous drainage surgery. There was a low incidence of serious side effects but nearly 60% were classified as failures by 3 years.