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Endoscopic cyclophotocoagulation combined with phacoemulsification vs phacoemulsification alone in glaucoma management: 5 year follow-up

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First Author: P.Gouws UK

Co Author(s):    A. Kennedy   H. Oliphant   L. Langsaeter              

Abstract Details

Purpose:

Evaluate the long term IOP lowering effect of endoscopic photocoagulation combined with phacoemulsification compared to phacoemulsification alone in patients on treatment for glaucoma or ocular hypertension.

Setting:

This is a single-center retrospective interventional study.

Methods:

The study population included all glaucoma patients within East Sussex Healthcare NHS Trust in the UK who had a cataract operation between 10/8/11 and 31/01/2018. All glaucoma patients who underwent phaco-ECP were included in the “phaco-ECP” or “study group”. All glaucoma patients undergoing phacoemulsification alone were included in the “phaco” or “control group”. Patients who had had previous glaucoma interventions, for example trabeculectomy, were not excluded and all glaucoma subtypes were included except acute angle closure glaucoma. Patients in both groups with POAG were also compared in a sub-group analysis.

Results:

In the phaco-ECP group (n=942) the IOP decreased from 16.6 ± 5.1 mmHg to: 14.0 ± 3.7 mmHg (year 1); 13.5 ± 3.4 mmHg (year 2); 13.6 ±3.5 mmHg (year 3); 13.5±3.3 mmHg (year 4); 13.3±3.7 mmHg (year 5). In the phaco only group (n= 789) the IOP decreased from 16.5 ± 4.0 mmHg to: 14.9 ±3.5 mmHg (year 1); 15.0 ± 4.6 mmHg (year 2); 14.8 ±3.5 mmHg (year3); 15.0±4.6mmHg (year 4); 14.6±3.8mmHg (year 5). The difference in IOP between the 2 groups was statistically significant at all time points. The average number of agents used in the phaco-ECP group reduced from 1.5 ± 0.9 to: 1.0 ± 0.9 (year 1); 1.0 ± 0.8 (year2); 1.1 ± 0.9 (year 3); 1.1 ± 0.9 (year4); 1.1 ± 0.9 (year 5) . The average number of agents used in the phaco group increased from 0.8 ± 0.8 to: 0.9 ± 0.8 (year 1); 0.9 ± 0.8 (year2); 1.0 ± 0.8 (year 3); 1.0 ± 0.8 (year4); 1.0 ± 0.8 (year 5) .Visual acuity improved to 6/7.5 in both groups at three years (p=0.2449, CI -0.178-0.046).

Conclusions:

In this series – the biggest cohort ever presented in the UK with the longest follow-up, the results demonstrate that phaco-ECP is an effective IOP lowering treatment option in glaucoma with cataract. The effect persisted for the 5 years with IOP returning to almost baseline levels in the phaco only group at this time point.

Financial Disclosure:

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