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  • Phaco-ECP for POAG: Results at Three Years

    By Lynda Seminara
    Selected by Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Eye (London)
    Published online Sept. 15, 2021

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    Endoscopic cyclophotocoagulation (ECP) is often considered for surgically naive patients with cataract and inade­quately controlled primary open-angle glaucoma (POAG). Yap et al. looked at the long-term safety and efficacy of phacoemulsification plus ECP (phaco-ECP) for such patients. They found that the safety of phaco-ECP was sustained through three years, although the effec­tiveness decreased somewhat.

    In this retrospective single-center series, the authors analyzed data for adults with POAG of any severity who underwent phaco-ECP from 2007 to 2017. The primary outcome measure was change in IOP of the first treated eye in each patient. Secondary out­comes included visual acuity, visual field indexes, medication burden, and surgical complications. Failure of the procedure was defined as IOP great­er than 21 mm Hg or less than 20% reduction at two consecutive visits, IOP lower than 5 mm Hg, or the need for additional IOP-lowering surgery.

    Altogether, 83 patients (83 eyes) were included in the study. Their mean IOP decreased significantly after surgery and remained low throughout follow-up. By one year, mean IOP had declined from 18.4 mm Hg (pre-op) to 14.3 mm Hg. Additional reductions were noted at year 2 (to 14.1 mm Hg) and year 3 (to 13.6 mm Hg). Con­sidering the criteria for failure, the procedure was deemed successful for 70% of patients at one year, 54% at two years, and 45% at three years. The mean burden of topical ocular hypotensive drugs was reduced significantly, from 2.7 medications at baseline to 1.3 at one year, which remained fairly steady thereafter (1.7 at two years and 1.8 at three years). Significant improvement in visual acuity from baseline was observed at all post-op visits. However, visual field indexes remained similar to those at baseline. The most com­mon complication was uveitis, which affected 6% of the study population. No patient had hypotony or retinal detach­ment, and only one patient required a second IOP-lowering surgery within the three years.

    These findings may be relevant for patients who could benefit from reducing topical medications, said the authors, even though failure rates appear to increase over time. Given the advantages of phaco-ECP, includ­ing minimal disruption to tissue, the authors recommend considering it as an alternative to minimally invasive procedures for glaucoma.

    The original article can be found here.