Combined cataract surgery and endoscopic cyclophotocoagulation in patients with glaucoma without prior

incisional glaucoma surgeryMatthew P. Traynor, MDMahmoud A. Khaimi, MD

Steven R. Sarkisian, Jr., MDDean McGee Eye Institute

The authors have no financial interests to disclose.

Purpose

• To determine the effect of combined endoscopic cyclophotocoagulation and cataract surgery on intraocular pressure, number of glaucoma medications, and visual acuity.

• To determine the safety of combined endoscopic cyclophotocoagulation and cataract surgery

Methods

• Retrospective chart review of all patients who underwent combined endoscopic cyclophotocoagulation and cataract surgery at the Dean McGee Eye Institute from January 2006 to February 2009.

• Exclusion criteria included prior incisional glaucoma surgery or cyclodestructive surgery in the study eye.

• 183 eyes of 137 patients were included in the study• 178 treated 360°, 3 treated 270°, 2 treated 180°• 73% POAG, 15% ACG, 3% Pigmentary glaucoma, 4% Normal

tension glaucoma, 2% PXG, 2% traumatic glaucoma, 1% NVG

Results

• IOP reduced from pre-op average of 18.8 mmHg to 16.8 mmHg at 6 months and 15.7 mmHg at 12 months

• IOP lowering medications reduced from pre-op average of 1.85 to 1.44 at 6 months and 1.33 at 12 months

• VA improved from an average of 20/53 pre-op to 20/40 post-op

Safety• Complications– Transient

• 16.4% (30/183) developed transient fibrin in the AC• 7.1% (13/183) recorded IOP spikes (IOP ≥ 30 mmHg and > 5 mmHg

over pre-op IOP)– 8 patients had early IOP spikes (within one month post-op)– 2 patients had late IOP spikes (after one month post-op)– 3 patients had early and late IOP spikes

– Chronic• 2.2% (4/183) developed CME• 2.2% (4/183) developed chronic anterior uveitis• 1 patient developed ocular ischemic syndrome • 1 patient suffered corneal decompensation requiring a corneal

transplant

Outcomes• Treatment success

– 86.3% (158/183) reached an IOP lower than 21 mmHg and lower than their pre-operative IOP

– 62.8% (115/183) maintained an IOP lower than 21 mmHg and lower than their pre-operative IOP over a mean follow-up of 8.1 months (±5.4)

• Treatment failure– 4.9% (9/183) required incisional glaucoma surgery within 18

months of Phaco/ECP• 6 Trabeculectomy/ExPress• 2 Glaucoma drainage implant• 1 Canaloplasty

– 2.7% (5/183) received SLT within 18 months of Phaco/ECP

Conclusions

• Endoscopic cyclophotocoagulation combined with cataract surgery resulted in the following:– Statistically significant lowering of intraocular pressure by

2-3 mmHg at 3 months, 6 months, 12 months, and 15 months

– Statistically significant mean decrease in IOP lowering medications at 3 months, 6 months, 9 months, 12 months, and 15 months

– >85% of patients demonstrated a lowering of IOP with over 60% of patients maintaining a lower IOP throughout their follow-up

Conclusions

• Endoscopic cyclophotocoagulation combined with cataract surgery resulted in the following:– 5.5% (10/183) of patients developed chronic

problems following surgery– 4.9% (9/183) of patients required subsequent

incisional surgery due to inadequate pressure control

Conclusions

• Endoscopic cyclophotocoagulation combined with cataract surgery is a reasonably safe and effective procedure.

• Phaco/ECP reduces patient dependency on medications while avoiding some of the complications of glaucoma filtration surgery. – Hypotony related complications including maculopathy,

choroidal effusions, and optic disc edema were not demonstrated in any of the study eyes.