Phacoemulsification With Endoscopic Cyclophotocoagulation Vs. Phacoemulsification Alone (Phepha) In Primary Angle Closure: A Randomized Clinical Trial

To determine whether adding endoscopic cyclophotocoagulation to phacoemulsification provides superior intraocular pressure (IOP) reduction and a decrease in medication burden compared with phacoemulsification alone in patients with primary angle closure.

Glaucoma Department, King Khaled Eye Specialist Hospital (KKESH), a tertiary care center in Riyadh, Saudi Arabia.

This randomized clinical trial included phakic patients with PAC with or without glaucoma. Participants were randomized to either Phaco-ECP (PHE) or Phaco-alone (PHA). The primary outcome was the reduction in IOP at 12 months. Secondary outcomes included the number of glaucoma medications and visual outcomes (logMAR BCVA and residual refractive error).

94 patients were enrolled (47 PHE; 47 PHA). Baseline characteristics were similar, including age ($P=0.552$) and IOP (PHE: $18.09\pm 3.35$; PHA: $17.57\pm 4.11$ mmHg; $P=0.507$). At 12 months, both groups achieved significant IOP reductions (PHE: $15.2\pm 2.5$; PHA: $13.8\pm 5.7$ mmHg), with no significant difference ($P=0.139$). Medication use declined significantly (PHE: $2.1\pm 1.1$ to $0.7\pm 0.9$; PHA: $2.2\pm 1.2$ to $0.5\pm 0.9$; $P=0.275$). Visual acuity improved in both ($P=0.635$). Residual refractive error was comparable (PHE: $0.78\pm 1.21$ D; PHA: $0.74\pm 0.87$ D; $P=0.829$).

In patients with primary angle closure, the addition of ECP to phacoemulsification did not provide a statistically significant additional reduction in IOP or medication burden at 12 months compared to phacoemulsification alone.