Staged Slow Coagulation Cyclophotocoagulation Before Phacoemulsification In Phacomorphic Glaucoma: A Pressure-Stabilizing Strategy

To evaluate the efficacy and safety of slow coagulation cyclophotocoagulation (SC-CPC) as a pressure-stabilizing bridge in phacomorphic glaucoma with mature cataract and uncontrolled high intraocular pressure (IOP). Severe IOP elevation frequently induces corneal edema that prevents safe phacoemulsification. Rapid IOP reduction through SC-CPC may enable endothelial recovery and corneal clearing, allowing safer staged cataract extraction.

The study was performed at the International Clinic in Orhei, Moldova, a private tertiary ophthalmology center with integrated glaucoma and cataract surgery services.

Prospective interventional case series of 16 eyes with phacomorphic glaucoma and uncontrolled IOP despite maximal medical therapy. All eyes underwent transscleral SC-CPC using an 810 nm diode laser (FOX IV, ARC Laser, Germany). Laser settings were 1250–1500 mW power and 3500–4000 ms duration per application. Eight to ten applications were delivered over 230–270 degrees, with a total energy of 120 J. Phacoemulsification with intraocular lens implantation was performed after corneal clarity and IOP stabilization. Outcomes included best-corrected visual acuity (BCVA), IOP, medication burden, time to corneal clearing, and complications.

Mean preoperative IOP was 54 ± 8 mmHg (range 42–68 mmHg). One week after SC-CPC, mean IOP decreased to 21 ± 6 mmHg, representing a 61% reduction (p < 0.001). Mean preoperative BCVA was counting fingers to hand motion. Corneal clarity sufficient for safe surgery was achieved after 5-10 days. Phacoemulsification was performed at 7-12 days. Medication burden decreased significantly, with systemic therapy discontinued in all cases. At final follow-up, IOP remained ≤21 mmHg in the majority of eyes. BCVA improved in all cases, ranging from 0.2 to 0.5 (p < 0.001). Visual outcome was primarily limited by pre-existing glaucomatous optic neuropathy. No hypotony, phthisis, or other complications occurred.

In phacomorphic glaucoma with extreme IOP elevation and corneal edema, staged SC-CPC provides rapid and controlled pressure reduction, allowing corneal recovery within approximately one week and facilitating safer delayed phacoemulsification. Significant visual improvement can be achieved when irreversible optic nerve damage is limited. SC-CPC represents a controlled, tissue-sparing bridge strategy in complex lens-induced glaucoma.