Comparing The Effectiveness Of Phacoemulsification + Endoscopic Photocoagulation Laser And Phacoemulsification Alone In The Treatment Of Primary Open Angle Glaucoma In Patients With Cataract: Concept Study- One Year Randomised Controlled Trial Result

To report 1 year outcomes of a randomised controlled trial comparing differences in intraocular pressure, medication use, refractive outcomes and adverse events between participants randomised to receive cataract surgery alone or cataract surgery with endoscopic cyclophotocoagulation (ECP).

UK based, multicentred, randomised controlled surgical interventional landmark study.

Patients had a washout period prior to surgery and at 1 year post surgery in which all glaucoma medications were stopped. Intraocular pressure was measured at 9 and 11am. Randomisation occured at the point of uncomplicated cataract surgery. Patients and follow up investigators were masked to treatment allocation.

79 - cataract surgery with ECP and 83 - cataract surgery alone. Mean IOP reductions were higher with phaco ECP (-5.85 [SD6.75] versus -5.28 [SD5.38]). Median IOP was also calculated given non normal distribution of IOP outcomes, which also found a higher reduction for ECP (-7.5 versus -5.5).

Success defined as IOP ≤ 21 and ≥ 20% reduction from baseline was seen in 41% of control cases and 54.4% of ECP cases. Medication reduction was similar in both arms (-0.7 control vs -0.8 ECP) . Adverse events were monitored; higher rates of anterior uveitis were seen in the ECP arm compared to phaco (27% versus 6%). CMO rates were similar (9% versus 6%).

ECP demonstrates a greater reduction in mean and median IOP as well as success rates, refractive outcomes and medication reductions were similar. Most adverse events seen with ECP were self limiting but higher rates of uveitis were noted.