Posters

Endoscopic cyclophotocoagulation combined with phacoemulsification vs phacoemulsification alone in glaucoma management

Poster Details

First Author: A.Kennedy UK

Co Author(s):    H. Oliphant   L. Laneaster   P. Gouws              

Abstract Details

Purpose:

Glaucoma is an important cause of sight loss. In its chronic form, it is a progressive optic neuropathy with several risk factors including genetics, ethnicity and the modifiable intra-ocular pressure. In patients with visually signifcant cataract, phacoemulsification can be combined with endoscopic cyclophotocoagulation (phaco-ECP) to improve vision with the added benefit of improving (IOP) control. However, there is a lack of long term data comparing phaco-ECP with phacoemulsification alone (phaco-alone) in glaucoma. The aim of this study is to establish the effect of phaco-ECP versus phacoemulsifiacation alone on the management of glaucoma over a three-year follow-up period.

Setting:

Conquest Hospital, The Ridge, Hastings, Saint Leonards-on-sea TN37 7RD

Methods:

Design: retrospective single-centre interventional comparative study Population: all glaucoma patients undergoing phaco alone (253 eyes) or phaco-ECP (198 eyes) between 10/8/11 and 16/12/14 Main outcome measures: Number of agents, IOP and visual acuity (VA) at pre-op and 1, 2 and 3 years post-op. Other outcome measures: Drop-out rates, further glaucoma intervention rates, sub-group analysis ECP: -810nm diode laser via a fibre-optic cable using a Xenon light aiming beam -performed after IOL insertion -probe inserted via main port and side incision to cover 360�Â�°; inserted after inflation of ciliary sulcus with viscoelastic -laser used in �â�€�˜paint mode�â�€�™ to �â�€�˜paint�â�€�™ ciliary processes

Results:

Average number of agents pre-op was 2.1 in phaco-ECP and 1.7 in phaco-alone groups. It was 1 compared to no change after one year (p<0.0001, CI 0.53-0.98) and 1.4 compared to 1.8 after three years (p=0.0230, CI 0.05-0.65) respectively. Average IOP (mmHg) pre-op was 17.5 in phaco-ECP and 15.8 in phaco-alone groups. One year IOP was 13.6 and 14.2 (p=0.1122, CI -0.13-1.27) and three year was 13.1 and 14.7 (p=0.0005, CI 0.71-2.49) respectively. VA pre-op was 6/12 in phaco-ECP and 6/15 in phaco-alone groups. It was 6/7.5 in both groups at three years (p=0.2449, CI -0.178-0.046).

Conclusions:

In conclusion, there is a clear initial drop in the amounts of agents used and IOP in the study group compared to the control group. At the three-year time-point, the average number of agents is almost equal between the two groups but the IOP remains 2mmHg lower in the study group. Phaco-ECP is therefore an effective treatment option in patients with POAG and cataract for at least three years and further study is required to establish longer term effect.

Financial Disclosure:

NONE