Clinical Ophthalmology (Aug 2021)
Long-term Surgical Outcomes of Phacoemulsification with Endoscopic Cyclophotocoagulation vs Phacoemulsification with Trabeculectomy and Mitomycin in Cataract and Glaucoma Patients
Abstract
Medhat A Bakr,1 Naif K Al-Mutairi2 1Immam Abdulrahman Bin Faisal University, King Fahd University Hospital, Ophthalmology Department (Glaucoma Section), Al Khobar, Eastern Province, Kingdom of Saudi Arabia; 2Jeddah Eye Hospital, Jeddah, Kingdom of Saudi ArabiaCorrespondence: Medhat A BakrKing Fahd University Hospital, Immam Abdulrahman Bin Faisal University, Alaqrabia, Al Khobar, Kingdom of Saudi ArabiaTel +966559753252Email [email protected]: To evaluate the long-term surgical outcomes of endoscopic cyclophotocoagulation (ECP) after four years follow-up in cataract and glaucoma patients that needed combined phacoemulsification and ECP (phaco-ECP) in comparison to combined phacoemulsification with trabeculectomy (phaco-trabeculectomy) with mitomycin C (MMC).Patients and Methods: Retrospective case–control study of 34 patients (34 eyes) with glaucoma who underwent phaco-ECP compared with phaco-trabeculectomy in tertiary eye specialist hospital in Saudi Arabia from 2010 to 2012. Participants were enrolled in two groups; ECP and trabeculectomy with MMC when combined with phacoemulsification. Success is defined as complete success when the IOP ≤ 21 mmHg without medication, qualified success when the IOP ≤ 21 mmHg with aid of topical medication.Results: Mean IOP decreased from 25.76 SD ± 8.227 to 15.24 SD ± 7.049 at last visit in phaco-trabeculectomy group and from 21.47 SD ± 4.215 to 12.88 SD ± 3.480 in phaco-ECP group. Mean medication use reduced from 2.89 SD ± 0.3 preoperatively to 1.50 SD ± 1.1 postoperatively (P< 0.001) in phaco-trabeculectomy group. It reduced in phaco-ECP group from 2.24 SD ± 0.8 preoperatively to 2.00 SD ± 0.9 postoperatively, 35.3% of phaco-trabeculectomy group developed vision-threatening complications while 0% in phaco-ECP group (P< 0.001), 29.4% in phaco-trabeculectomy group required second surgical intervention compared to 17.6% in phaco-ECP group. In phaco-trabeculectomy group, 29.4% reached complete success, meanwhile in phaco-ECP group, 64.7% reached qualified success (P=0.026).Conclusion: ECP illustrates significant reduction of IOP and less postoperative complications if associated with phacoemulsification. Furthermore, it is safe and effective as a primary procedure alternative to combined cataract and trabeculectomy surgery for glaucoma patients having cataract and requiring surgical intervention.Keywords: cataract, extraction, phacoemulsification, trabeculectomy, glaucoma; ECP Endoscopic cyclophotocoagulation
