COMMENTARY

Endoscopic Cyclophotocoagulation Plus Cataract Extraction in Glaucoma Patients

Shuchi B. Patel, MD

Disclosures

August 17, 2016

Efficacy of Combined Cataract Extraction and Endoscopic Cyclophotocoagulation for the Reduction of Intraocular Pressure and Medication Burden

Roberts SJ, Mulvahill M, SooHoo JR, Pantcheva MB, Kahook MY, Seibold LK
Int J Ophthalmol. 2016;9:693-698

Study Summary

A retrospective case review of 91 eyes with glaucoma and cataract that underwent combined phacoemulsification cataract extraction and endoscopic cyclophotocoagulation (PCE/ECP) surgery was performed. Patients included in the review were those who needed surgery for a visually significant cataract and uncontrolled intraocular pressure (IOP) or glaucoma medication intolerance.

The surgical procedure was performed by one of three surgeons and included removal of the cataract using a divide-and-conquer technique through a 2.4-mm clear corneal incision. ECP was performed through the same corneal incision after placement of the intraocular lens. The laser energy was set on continuous duration with a power of 0.25 W, and 200-270° of nasal ciliary body was treated in a continuous fashion. The treatment endpoint was contraction and whitening of the processes, with care taken to avoid rupture of any ciliary processes.

Treatment failure was defined as any of the following:

  1. Less than 20% reduction in IOP at two consecutive follow-up visits;

  2. IOP ≥ 21 mm Hg or ≤ 5 mm Hg at two consecutive follow-up visits; or

  3. Additional glaucoma surgery within 12 months of undergoing PCE/ECP.

After statistical analysis of the data, results showed that the mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12 months. The mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12 months. The success rate decreased at each postoperative visit, starting at 73.6% at 3 months and dropping to 49.7% by 1 year. The majority of eyes met criteria for failure on the basis of insufficient IOP reduction.

No patient demographic characteristics were associated with treatment success. The only ocular characteristic that was associated with treatment success was a higher baseline IOP.

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