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Combined phaco, ECP shows modest but significant results
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Combined phacoemulsification and endocyclophotocoagulation achieved “modest but significant” IOP-lowering results in patients with uncontrolled glaucoma at 3 years in a study.
A retrospective analysis was conducted on the results over 3 years of 84 patients who underwent the double procedure as an attempt to treat uncontrolled glaucoma, progressing in spite of maximally tolerated medical therapy.
The primary outcome measure was IOP reduction at 3 years. Secondary outcomes were complications and failure of the surgical procedure defined as IOP higher than 21 mm Hg or lower than 6 mm Hg or reduced by less than 20% from baseline, as well as need for further laser or other surgery.
The 360° endocyclophotocoagulation (ECP) was performed after standard phacoemulsification surgery with IOL implantation. A standard 250 mW power setting was used. The exposure time and total power delivery were varied according to individual reaction to the treatment to achieve whitening and contraction of the ciliary process tissue and the ciliary epithelium.
Mean IOP dropped from 18.7 mm Hg preoperatively to 14 mm Hg at 3 years, representing a 25% reduction. Cystoid macular edema was the most common complication, occurring in 8.4% of the patients, and resolved without permanent sequelae.
The authors interpreted these results as a demonstration of the positive effects of combined phaco and ECP, although 60% of the patients were classified as failures based on the established criteria, which comply with the standard criteria used in most glaucoma surgical trials.
The study did not separate the IOP-lowering effect of ECP and phaco. However, the 25% mean drop in IOP was significantly higher than the average 9% drop reported by most studies where phaco alone was used.
“Overall, the evidence does appear to support the conclusion that phaco-ECP is more effective at reducing IOP than phaco alone,” the authors wrote.
“How the procedure compares with the newer micro-invasive glaucoma surgeries remains uncertain,” they added, and concluded that “further research is required to determine the place of phaco-ECP in the ever-increasing number of procedures available to glaucoma patients.”– by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
Traditional glaucoma surgery often results in a complex postoperative course due to concerning complications. Therefore, we continue to look for ways to lower IOP in patients without having to perform these invasive procedures. Minimally invasive glaucoma surgery (MIGS) is a promising development, but what about reapplying an older technique?
Transscleral cyclophotocoagulation has historically been used exclusively in blind, painful eyes with high IOP. A newer endoscopic form of the procedure, ECP, allows for direct visualization of the ciliary processes during cataract surgery and results in IOP reduction with less overall tissue destruction. How does it stack up?
Smith and colleagues, in their 3-year postoperative retrospective analysis, found that ECP, when performed in conjunction with cataract surgery, yielded a 25% reduction in IOP. Cataract surgery alone has been found to lower IOP about 10% on average, so this is a modest effect.
While we continue to strive to find the optimal minimally invasive procedure, ECP may give doctors an additional option to slightly lower IOP in a relatively noninvasive fashion, but it’s a tough sell given the many alternative options. It has made its way on the list, but it is probably not at the top….
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