Six Year Outcomes Of Combined Phacoemulsification Surgery And Endoscopic Cyclophotocoagulation In Refractory Glaucoma

Published 2022 - 40th Congress of the ESCRS

Reference: PP15.14 | Type: Free paper | DOI: 10.82333/t9w3-g746

Authors: Leo Feinberg* ¹ , Andrew Swampillai ¹ , Daniel Byles ¹ , Michael Smith ¹

¹West of England Eye Unit,Royal Devon and Exeter Hospital NHS Foundation Trust,Exeter,United Kingdom

Purpose

To describe the 6-year results of combined phacoemulsification surgery and endoscopic cyclophotocoagulation (phaco-ECP) surgery in patients with refractory glaucoma and no previous glaucoma surgery.

Setting

This is a non-comparative retrospective case series in patients with uncontrolled glaucoma undergoing phaco-ECP between January to October 2013, performed at the West of England Eye Unit, a university teaching hospital in the United Kingdom.

Methods

Retrospective case series of 84 eyes with glaucomatous progression despite maximally tolerated medical therapy. The primary outcome measure was intraocular pressure (IOP) reduction 6 years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 6 years. Failure was defined as IOP higher than 21 mm Hg or lower than 6 mm Hg, IOP not reduced by 20% from baseline at the 1, 2, 3, 4, 5, or 6-year timepoints or further laser or other surgery to reduce IOP at any timepoint.

Results

There was a statistically significant decrease in mean IOP from 18.9 mmHg pre-operatively to 13.7, 12.8, 13.0, 12.7, 12.5, 12.3 mmHg, at the 1, 2, 3, 4-, 5-, and 6- years post-operatively respectively (p < 0.001). 57 (68%) reached criteria for failure by six years. In 36% of cases this was due to inadequate IOP control whereas 32% required further laser or surgery. When we excluded patients who only had selective laser trabeculoplasty rather than further surgery the failure rate reduced to 51%. 11% had a post-operative complication, 2.4% requiring further surgical intervention.

Conclusions

At 6 years postoperatively, combined phaco-ECP achieved a significant reduction in IOP in patients with uncontrolled glaucoma and no previous drainage surgery. Significant complications were uncommon but 68% were classified as surgical failures by the 6 year point.