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Cataract and Glaucoma Surgery: Endoscopic Cyclophotocoagulation versus Trabeculectomy.

Sheila Marco1, Karim F Damji2, Samir Nazarali3

  • 1Department of Ophthalmology, University of Nairobi, Nairobi, Kenya.

Middle East African Journal of Ophthalmology
|February 10, 2018
PubMed
Summary

Endoscopic cyclophotocoagulation (ECP) combined with cataract surgery showed similar intraocular pressure (IOP) reduction to trabeculectomy (trab) but had more postoperative IOP spikes and inflammation. ECP-phaco required more medications for qualified success.

Keywords:
Endoscopic cyclophotocoagulationglaucomatrabeculectomy

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Cataract Surgery

Background:

  • Glaucoma management often requires surgical intervention to lower intraocular pressure (IOP).
  • Combining glaucoma surgery with cataract extraction can improve efficiency and patient outcomes.
  • Endoscopic cyclophotocoagulation (ECP) and trabeculectomy (trab) with mitomycin C are surgical options for IOP reduction.

Purpose of the Study:

  • To compare the efficacy and safety of ECP combined with phacoemulsification (phaco) versus trabeculectomy combined with phacoemulsification (trab-phaco).
  • To evaluate outcomes including intraocular pressure (IOP), medication use, visual acuity, and complications at 6 months post-surgery.

Main Methods:

  • A prospective study evaluating 53 eyes undergoing either ECP-phaco or trab-phaco.
  • Primary outcome: mean IOP at 6 months.
  • Secondary outcomes: change in glaucoma medications, visual acuity, intraocular inflammation, and postoperative complications. Success defined by target IOP and medication use.

Main Results:

  • No significant difference in mean IOP between ECP-phaco (14.2 ± 3.6 mmHg) and trab-phaco (13.0 ± 2.5 mmHg) at 6 months.
  • Complete success rates were significantly lower for ECP-phaco (25.0%) compared to trab-phaco (69.0%) (P = 0.002).
  • ECP-phaco showed higher incidences of postoperative IOP spikes and anterior chamber inflammation, but similar complication rates to trab-phaco.

Conclusions:

  • ECP-phaco and trab-phaco provide comparable IOP reduction and visual acuity improvement at 6 months.
  • ECP-phaco is associated with a higher need for additional medications for qualified success.
  • ECP-phaco patients experienced more immediate postoperative IOP spikes and anterior chamber inflammation.