'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma.
OBJECTIVE
Does phaco-ECP reduce intraocular pressure? Is phaco-ECP safe?


METHODS
Retrospective case note review of all patients undergoing phaco-ECP between June 2008 and June 2009. All glaucoma subtypes were included.


METHODS
Single District General Hospital Ophthalmology Department within the UK.


METHODS
58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8).


METHODS
All patients received combined cataract surgery and endoscopic cyclophotocoagulation.


METHODS
Follow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed.


RESULTS
Of the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout.


CONCLUSIONS
This study confirms the safety of phaco-ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco-ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm Hg) are indicated.
Department of Ophthalmology, Frimley Park Hospital, Camberley, UK.
Dan
D
Lindfield
Robert W
RW
Ritchie
Michael Fp
MF
Griffiths