Intermediate results of phaco-endocycloplasty in an exclusive cohort of angle closure glaucoma: potential for change
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The objective of this study was to investigate the efficacy and safety of phaco-endocycloplasty in an exclusive cohort of primary angle closure disease/glaucoma.
The study was interventional and non-comparative, carried out at a tertiary level eye care Institute. All adult patients (> 18 years) with angle closure disease, who had controlled or uncontrolled intra-ocular pressure (IOP) and had visually significant cataract, requiring surgery, and had undergone phaco-endocycloplasty, performed for 180°–210° simultaneously with cataract surgery, were included.
Main outcome measures
Primary outcome measure includes IOP, and secondary outcome measures include best corrected logMAR visual acuity (BCVA), anti-glaucoma medication (AGM) and complications.
Thirty-two eyes of 28 patients were included. Median follow-up was 15 months (range 3–42 months, Q1 7.5, Q3 18, IQR 10.5). Median IOP pre-procedure (20.5 mmHg, range 11–46, Q1 16.75, Q3 31, IQR 14.25) decreased significantly post-procedure at last follow-up (IOP 16 mmHg, range 10–20, Q1 12, Q3 17.5, IQR 5.5) (p < 0.001). There was significant decrease in use of AGM (median 3 pre-procedure, range 1–5, Q1 2, Q3 3.25, IQR 1.25) at last follow-up (median 0) (p < 0.001) post-procedure. Median logMAR BCVA improved from 0.4 (Q1 0.3, Q3 0.625, IQR 0.325) to 0.05 (Q1 0, Q3 0.3, IQR 0.3) at last follow-up (p < 0.001). None of the patients had serious sight-threatening complications.
This study indicates that phaco-endocycloplasty can effectively control IOP, significantly reducing need for AGM, without compromising safety, in angle closure glaucoma. When combined surgery is indicated, this conjunctiva-sparing procedure may be employed in the management of coexisting cataract and glaucoma prior to bleb-forming surgery.
KeywordsEndocycloplasty Phaco-endocycloplasty Primary angle closure glaucoma Endocyclophotocoagulation
Author thanks IIK Ahmed, MD, University of Toronto, Department of Glaucoma, Credit Valley Eye Care, 3200 Erin Mills Parkway, Mississauga, Ontario, Canada L5L 1W8.
Compliance with ethical standards
Conflict of interest
None relevant (Novartis, Allergan).
ESM 1: Video that demonstrates technique of phaco-endocycloplasty and ECPL in pseudoexfoliation (MOV 48,142 kb)
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