Three Year Follow Up Of Combined Endocyclophotocoagulation, Istent And Phacoemulsification In Surgically Naïve Patients With Primary Open Angle Glaucoma

To assess the long-term efficacy and safety of phacoemulsification combined with endocyclophotocoagulation and iStent implantation in primary open angle glaucoma.

Retrospective observational cross-sectional study of surgically naïve eyes treated with combined phacoemulsification, iStent and endocyclophotocoagulation. All surgeries were performed at a single facility (Queen Victoria Hospital, East Grinstead, UK) between January 2018 and July 2019. All patients signed an informed consent form prior to the surgery. Clinical trial registration of the study was not required. 

82 eyes of patients that met the following criteria were included: being over 18 years of age, primary open angle glaucoma, visually significant cataract, open angle on gonioscopy, no previous eye surgery , reliable visual field test at baseline. Patient’s data were accessed online and the following were collected at baseline, year 1, 2 and 3: best corrected visual acuity, intraocular pressure, visual field mean deviation and pattern standard deviation, number of topical glaucoma medication, post-operative complications and subsequent glaucoma surgeries. Comparisons between preoperative and post-operative data were performed by using T-Test dependent for paired samples with a p value of <0.01 considered as statistically significant.

Out of 82 eyes 60.97% were female and mean age was 80.95 years. Preoperatively, mean IOP was 19.15mmHg, this dropped to 13.84mmHg at year 1, 14.11mmHg at 2 and 14.4mmHg at 3. IOP reduction was statistically significantly lower than baseline at all time points (p<0.01). Patients were on a mean of 2.05 topical medication. Which decreased to 1.38 at year 1, 1.35 at year 2 and 1.31 at year 3. This results were statistically significant (p<0.01). Basal MD was -5.5dB. Postoperatively, the MD was -7.48dB at year 1, -5.44dB at year 2 and -5.44dB at year 3. No significant change was found from baseline in either parameter (p>0.01). Two patients developed postoperative CMO. No patients needed further surgical tintervention. 

The combination of phacoemulsification with iStent implantation and endocyclophotocoagulation provides long term statistically significant IOP reduction as well as reduction of medication burden. IOP after the procedure was controlled in a very stable manner over the 3 years follow up. This surgical technique has proved a very safe profile and could be first line treatment for phakic eyes with primary open angle glaucoma.