Three-years follow-up of combined phacoemulsification, iStent and endocyclophotocoagulation

ObjectivesTo assess the efficacy and safety of phacoemulsification combined with endocyclophotocoagulation (ECP) and iStent implantation in surgically naïve patients.MethodsRetrospective observational cross-sectional series of 82 surgically naïve eyes treated with combined phacoemulsification, ECP and iStent between January 2018 and July 2019 at a single centre facility.ResultsA total of 82 eyes underwent the procedure. Average age was 80.9 (±6.4) years and 61% were female. Fifteen (18.29%) eyes had preperimetric glaucoma, the remaining were primary open angle glaucoma as follows: mild 32.92% (N = 27), moderate 35.37% (N = 29) and advanced 13.41% (N = 11). Baseline mean IOP was 19.5 (±4.5) mmHg, falling to 14.4 (±3.2) mmHg at 36-months (p ≤ 0.001). 82% of eyes were a qualified success at 3-year post-op with IOP ≤ 18 mmHg. 26% of eyes were a complete success at 3-years with IOP ≤ 18 mmHg and no medications. At baseline, mean number of medications was 2 reducing to 1.3 ± 1.1 at 3-years; Nineteen (23.2%) were patients medication-free. Best corrected visual acuity improved, increasing from 0.28 ± 0.2 LogMAR preoperatively to 0.10 ± 0.1 LogMAR at 36-months follow-up (p ≤ 0.001). Two patients developed cystoid macular oedema that resolved with topical treatment. Average MD remained stable over 3-years (p = 0.94). Due to suboptimal IOP, 3 patients underwent selective laser trabeculoplasty (SLT). No patients required further glaucoma surgical intervention.ConclusionsCombination of cataract surgery with iStent and ECP is a safe and effective procedure to lower IOP and medication burden. The procedure halted glaucoma progression and prevented further surgery over a 3-years follow up.