Intermediate results of phaco-endocycloplasty in an exclusive cohort of angle closure glaucoma: potential for change

The objective of this study was to investigate the efficacy and safety of phaco-endocycloplasty in an exclusive cohort of primary angle closure disease/glaucoma.

The study was interventional and non-comparative, carried out at a tertiary level eye care Institute. All adult patients (> 18 years) with angle closure disease, who had controlled or uncontrolled intra-ocular pressure (IOP) and had visually significant cataract, requiring surgery, and had undergone phaco-endocycloplasty, performed for 180°-210° simultaneously with cataract surgery, were included.

Primary outcome measure includes IOP, and secondary outcome measures include best corrected logMAR visual acuity (BCVA), anti-glaucoma medication (AGM) and complications.

Thirty-two eyes of 28 patients were included. Median follow-up was 15 months (range 3-42 months, Q1 7.5, Q3 18, IQR 10.5). Median IOP pre-procedure (20.5 mmHg, range 11-46, Q1 16.75, Q3 31, IQR 14.25) decreased significantly post-procedure at last follow-up (IOP 16 mmHg, range 10-20, Q1 12, Q3 17.5, IQR 5.5) (p < 0.001). There was significant decrease in use of AGM (median 3 pre-procedure, range 1-5, Q1 2, Q3 3.25, IQR 1.25) at last follow-up (median 0) (p < 0.001) post-procedure. Median logMAR BCVA improved from 0.4 (Q1 0.3, Q3 0.625, IQR 0.325) to 0.05 (Q1 0, Q3 0.3, IQR 0.3) at last follow-up (p < 0.001). None of the patients had serious sight-threatening complications.

This study indicates that phaco-endocycloplasty can effectively control IOP, significantly reducing need for AGM, without compromising safety, in angle closure glaucoma. When combined surgery is indicated, this conjunctiva-sparing procedure may be employed in the management of coexisting cataract and glaucoma prior to bleb-forming surgery.