Six year outcomes of combined phacoemulsification surgery and endoscopic cyclophotocoagulation in refractory glaucoma.

Abstract

This study is to describe the 6-year results of combined phacoemulsification surgery and endoscopic cyclophotocoagulation (Phaco-ECP) surgery in patients with uncontrolled glaucoma and no previous glaucoma surgery. This is a retrospective case series of 84 eyes. The primary outcome measure was intraocular pressure (IOP) reduction 6years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 6years. Failure was defined as IOP higher than 21mm Hg or lower than 6mm Hg or IOP not reduced by 20% from baseline at the 1, 2, 3, 4, 5, or 6-year time points or further laser or other surgery to reduce IOP at any timepoint. There was a statistically significant decrease in mean IOP from 18.9mmHg pre-operatively to 13.7, 12.8, 13.0, 12.7, 12.5, and 12.3mmHg at the 1, 2, 3, 4, 5, and 6years post-operatively respectively (p < 0.001). Fifty-seven (68%) reached criteria for failure by 6years. In 36% of cases, this was due to inadequate IOP control, whereas 32% required further laser or surgery. When we excluded patients who only had selective laser trabeculoplasty rather than further surgery, the failure rate reduced to 51%. Eleven percent had a post-operative complication, 2.4% requiring further surgical intervention. At 6years postoperatively, combined phaco-ECP achieved a significant reduction in IOP in patients with uncontrolled glaucoma and no previous drainage surgery. Significant complications were uncommon, but 68% was classified as surgical failures by the six year point.