This article is more than 5 years old. Information may no longer be current.
Combined phaco-ECP lowers IOP
However, the decrease in IOP is modest and the combined therapy may not prevent progression in the long term.
Click Here to Manage Email Alerts
When faced with a patient who has uncontrolled glaucoma, the glaucoma specialist has an increasing number of therapies to choose from, one being combined phacoemulsification and 360° endocyclophotocoagulation.
Michael Smith, FRCOphth, and colleagues analyzed outcomes of the combined procedure in a retrospective case series of 84 eyes with uncontrolled glaucoma and no previous drainage surgery. At 3 years, mean IOP decreased 25%, but nearly 60% of patients were classified as failures. Failure was defined by one of two criteria: firstly, IOP greater than 21 mm Hg or less than 6 mm Hg or not reduced by 20% from baseline at the 1-, 2- or 3-year time point; or secondly, further laser or surgery to reduce IOP at any time point.
“This study suggests that for phakic patients with no previous drainage surgery, phaco-ECP is a reasonable option,” Smith told Ocular Surgery News.
However, in many patients, the IOP drop was modest, with 40% not achieving an IOP of 21 mm Hg or a 20% drop and 18% requiring further surgery. “Patients should therefore be warned that the procedure may not lower IOP enough in the long term to avoid further glaucomatous progression or the need for further laser or surgery,” Smith said.
Results
Mean IOP was 18.7 mm Hg at baseline and dropped to 13.3 mm Hg (28.8% decrease) at 1 year, 13.8 mm Hg (26.2% decrease) at 2 years and 14 mm Hg (25.1% decrease) at 3 years (all P < .0001). However, by the 3-year time point, 49 of the 84 patients had met one or more of the criteria for failure.
The most common additional procedure was selective laser trabeculoplasty, with only 7% of patients requiring trabeculectomy or glaucoma drainage device surgery.
“I don’t think the proportion of patients requiring further surgery was a significant finding of this study,” Smith said. “Of the 18% who underwent a further procedure, in 9.5% this was SLT, which is a quick and low-risk procedure, whereas only 7.1% underwent a trabeculectomy or glaucoma drainage device. This is similar to the 3-year results of the trabeculectomy arm of the TVT Study, where 13% needed further glaucoma drainage surgery. I think the main finding here is that although this procedure does reduce IOP, in many patients it may not reduce it enough, but this must be weighed against the potential benefits, especially in elderly patients,” he said.
The mean number of glaucoma medications needed before and after treatment was similar at 3 years: 2.6 preoperatively vs. 2.5 postoperatively.
Nine patients had a significant complication, with seven cases of cystoid macular edema, one prolonged corneal edema and one iris-IOL capture. In all cases the complications resolved without any long-term adverse outcomes, Smith said.
“As a quick procedure (20 to 30 minutes including the cataract surgery) with a lower incidence of side effects and a less arduous postoperative regimen than traditional glaucoma drainage surgery, it may be a good option in the substantial proportion of glaucoma patients who are elderly and have significant comorbidities. Further research is needed to compare the long-term results of phaco-ECP with other glaucoma procedures, especially the newer MIGS procedures,” Smith said. – by Robert Linnehan
- Reference:
- Smith M, et al. J Cataract Refract Surg. 2018;doi:10.1016/j.jcrs.2018.06.025.
- For more information:
- Michael Smith, FRCOphth, can be reached at West of England Eye Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, United Kingdom; email: smith.mic73@gmail.com.
Disclosure: Smith reports no relevant financial disclosures.