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  • Phaco-endocycloplasty for angle-closure glaucoma may reduce rate of complications, interventions

    Cataract/Anterior Segment, Glaucoma

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

    Pathak-Ray V, Choudhari N. Ophthalmology Glaucoma, November 2020

    This prospective randomized trial evaluated the efficacy of phacoemulsification combined with either endocycloplasty (ECPL) or trabeculectomy for primary angle-closure glaucoma.

    Study design

    Researchers assessed 45 phakic eyes (39 subjects) with primary angle-closure or primary angle-closure glaucoma after laser peripheral iridotomy (LPI). Twenty-five eyes underwent phacoemulsification and ECPL (phaco-ECPL) and 20 underwent phacotrabeculectomy. The primary outcome measure was IOP. Secondary outcome measures were BCVA, number of antiglaucoma medications, complications and failure.

    Outcomes

    Patients in the phaco-ECPL and phacotrabeculectomy groups were followed for a mean of 16 months and 19 months, respectively. The average preoperative and postoperative IOP, antiglaucoma medications use and BCVA did not differ between groups. However, the phacotrabeculectomy group had a higher rate of complications (13 vs. 8) and interventions (10 vs. 4).

    Limitations

    The study was mainly limited by the number of study eyes and the duration of follow-up. In addition, 5 eyes dropped out of the phaco-ECPL group. Although the differences in complications and interventions were statistically significant, it is difficult to determine the true incidence of these events when there was a 20% dropout in the phaco-ECPL group.

    Clinical significance

    Phacotrabeculectomy has been the gold standard approach for angle-closure disease, which has a high degree of morbidity. This study provides support that phaco-ECPL is equally efficacious without the trabeculectomy-related complications and interventions; most notably, aqueous misdirection only happened in the trabeculectomy group. This evidence further supports a stepwise, minimally invasive approach to angle-closure disease. In addition, phaco-ECPL offers a quicker recovery with fewer postoperative visits. If phaco-ECPL fails, a prudent glaucoma surgeon can still proceed with trabeculectomy.