COMMENTARY

Endoscopic Cyclophotocoagulation Plus Cataract Extraction in Glaucoma Patients

Shuchi B. Patel, MD

Disclosures

August 17, 2016

Viewpoint

After the approval of ECP, many studies have been conducted to determine its efficacy.[1,2,3] Studies have not only found data on the amount and success of IOP reduction but also compared the effect of ECP combined with PCE vs PCE alone. Other studies investigated the effect of ECP on medication burden and refractive outcome.[4] Subanalyses have attempted to determine whether the efficacy of ECP is different for primary open-angle glaucoma, secondary glaucoma, or angle-closure glaucoma. Each of these studies has provided important data regarding ECP.

The findings of this study were relatively consistent with those of previous studies on PCE/ECP. It is difficult to directly compare studies because the criteria for success were different for each study. The general findings of other studies and this study suggest that ECP is a safe procedure as an adjunct to cataract surgery to reduce IOP and medication burden. The IOP reduction seen when ECP is performed in conjunction with PCE is greater than that seen with PCE alone, although this study did not have a control group to corroborate the previously reported data.

Also, similar to previous studies,[3] this study showed that the 12-month success rate of sustained pressure reduction was close to 50%. Finally, this study showed that there is greater reduction in IOP with a higher baseline IOP, which was also suggested in previous studies.

This retrospective study provides more support for the use of ECP during PCE for patients with glaucoma to reduce IOP and medication dependence.

Compared with the gold standard of glaucoma filtration surgery for the management of glaucoma that is uncontrolled by medication or laser treatments, ECP has fewer vision-threatening complications and requires less follow-up by the patient.

Minimally invasive glaucoma surgery (MIGS) is also showing promise in successfully reducing IOP, without potential vision-threatening side effects. Compared with such procedures as Trabectome and iStent, ECP can be performed in patients with a narrow or closed angle. Therefore, ECP may be one of the few MIGS procedures that has widespread utility while still achieving therapeutic success in many subtypes of glaucoma.

Further studies will provide even more data on the efficacy of ECP and optimal patient selection as well as treatment parameters.

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