Phaco-endocycloplasty versus Phacotrabeculectomy in Primary Angle-Closure Glaucoma: A Prospective Randomized Study

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Innovation

Background:

• Primary angle-closure glaucoma (PACG) poses a significant risk to vision.
• Laser peripheral iridotomy (LPI) is a common initial treatment for PACG.
• Combined cataract and glaucoma surgery is often indicated for patients with visually significant cataracts and PACG.

Purpose of the Study:

• To compare the efficacy and safety of endocycloplasty (ECPL) combined with phacoemulsification (phaco-ECPL) versus phacotrabeculectomy.
• To evaluate outcomes in patients with primary angle-closure (PAC) or PACG after LPI.
• To assess intraocular pressure (IOP), visual acuity, medication use, complications, and need for interventions.

Main Methods:

• Prospective, interventional, randomized controlled trial.
• Inclusion of patients aged 30+ with PAC/PACG, post-LPI, and visually significant cataracts.
• Random assignment to either phaco-ECPL or phacotrabeculectomy for combined surgery.
• Primary outcome: intraocular pressure (IOP); Secondary outcomes: best-corrected visual acuity (BCVA), antiglaucoma medications (AGMs), complications, and failure.

Main Results:

• 45 eyes from 39 subjects were analyzed (25 phaco-ECPL, 20 phacotrabeculectomy).
• Mean follow-up was approximately 16-19 months.
• No significant differences in mean IOP, BCVA, or AGM between groups.
• Phacotrabeculectomy group experienced a higher rate of complications (P=0.011) and interventions (P=0.047).

Conclusions:

• Both phaco-ECPL and phacotrabeculectomy effectively lower IOP in PACG patients.
• Phacotrabeculectomy was associated with a greater incidence of complications and interventions.
• Further research with longer follow-up is warranted to establish phaco-ECPL as a potential first-line management option.