A UK case series of phaco-ECP

Abstract

Aims: Cataract surgery with combined endo-cyclophotocoagulation (phaco-ECP) remains a relatively new procedure for glaucoma specialists. Problems associated with trans-scleral photocoagulation and a lack of long-term data can cause reluctance to introducing the procedure. However, published data has shown that phaco-ECP is a valuable additional treatment for patients with concomitant cataract and glaucoma being low risk, quick and cost effective. Our retrospective case study reviews the outcome of a cohort of patients treated in one UK hospital from 2009-2013. Methods: All patients undergoing combined phaco-ECP at one UK hospital between September 2009 and November 2013 were included. All glaucoma subtypes were included as was previous surgery. We reviewed electronic and paper notes. Details collated include age, gender, glaucoma subtype, preoperative intraocular pressure (IOP) and number of topical glaucoma agents. Post-operative IOP and number of agents were collected at specified time points. The main outcome measures were IOP and number of agents used. We also report intraoperative and post-operative complications and further glaucoma operations needed. Results: 328 eyes were included of 207 patients. The mean age of participants was 78.8 years [SD +-10 years, range 62-100]. The group consisted of 52% males and 48% females. The longest follow-up was 48 months. The mean follow-up was 24 months. 154 eyes were followed up for 12 months and 105 for 24 months or more. 69 eyes were followed up for less than a year. Two of these had just two follow ups (due to passing away). The remainder were patients who had recently had surgery at the time of the audit and 9 people lost to follow-up. Two patients who passed away after the first post-op visit were excluded from the results. All eyes who had measurements available at any specific timepoint were included in the data for that part of the study. Pre-operatively, patients used a mean of 1.72 agents [SD 1.07, range 0-4] and pre-operative IOP mean was 17.1 [ SD 5.3, range 15-41]. The one patient who had a starting pressure of 15mmHg was on maximum tolerated medical treatment and had progressing visual field changes despite this. All the patients included in the treatment were clinically considered to be requiring additional treatment to their current tolerated medical regime due to progressive glaucoma changes. 134 patients included in the study had a pre+op IOP of <21 mm Hg but were all considered uncontrolled clinically. One year post-operatively the patients used a mean of 0.77 agents [SD 0.66, range 0-3] and IOP mean was 13.2 [SD 3.06, range 5-21]. The overall reduction in IOP at 24 months was 24.0% and the overall reduction in the number of agents used at 24 months was 38.0%. This is the biggest reported UK cohort. There were no contraindications found to perform this procedure on any of our patients. Subgroup analysis of the different glaucoma subgroups will follow as well as a further case-controlled study of phaco only patients.