Dataset Information

'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma.

ABSTRACT:

Objectives

Does phaco-ECP reduce intraocular pressure? Is phaco-ECP safe?

Design

Retrospective case note review of all patients undergoing phaco-ECP between June 2008 and June 2009. All glaucoma subtypes were included.

Setting

Single District General Hospital Ophthalmology Department within the UK.

Participants

58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8).

Interventions

All patients received combined cataract surgery and endoscopic cyclophotocoagulation.

Outcome measures

Follow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed.

Results

Of the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm?Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm?Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm?Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm?Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout.

Conclusions

This study confirms the safety of phaco-ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco-ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm?Hg) are indicated.

SUBMITTER: Lindfield D

PROVIDER: S-EPMC3367146 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma.

Lindfield Dan D Ritchie Robert W RW Griffiths Michael Fp MF

BMJ open 20120530 3

<h4>Objectives</h4>Does phaco-ECP reduce intraocular pressure? Is phaco-ECP safe?<h4>Design</h4>Retrospective case note review of all patients undergoing phaco-ECP between June 2008 and June 2009. All glaucoma subtypes were included.<h4>Setting</h4>Single District General Hospital Ophthalmology Department within the UK.<h4>Participants</h4>58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8).<h4>Interventions</h4>All patients received combined cataract surgery and endoscopic cyclop ...[more]

PMID: 22649172

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Project description:PurposeTo establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor (VEGF) injection, pars plana vitrectomy (PPV), endoscopic pan-retinal photocoagulation (PRP), and endoscopic cyclophotocoagulation (ECP) surgery for neovascular glaucoma (NVG) patients.MethodsThis retrospective study included 30 patients (30 eyes) who were suffering from NVG and treated with PPV & PRP & ECP (ECP group, 16 eyes), or Ahmed glaucoma valve implantation (Ahmed group, 14 eyes). The intraocular pressure (IOP), number of postoperative anti-glaucoma medications, best-corrected visual acuity (BCVA), successful rate of surgery, and postoperative complications were recorded and statistically analyzed at the time points of preoperative, 1-day, 1-month, 3-months, 6-months, and 12-months after operation.ResultsAn obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation (P < 0.05), and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months (P = 0.014) and 12-months (P = 0.047) postoperative time points, while there was no significant difference of medication number between the two groups except for 1-day after surgery. The BCVA showed no marked difference between the two groups preoperatively and postoperatively (P > 0.05), while it was significantly improved in ECP group at 3-months (P = 0.001), 6-months (P = 0.004), and 12-months (P = 0.010) time points comparing with preoperative BCVA. The surgical success rates in ECP group were also slightly higher than Ahmed group. And the complications after operation showed no marked differences.ConclusionsThe comprehensive treatment of PPV, endoscopic PRP, and ECP surgery for NVG patients after anti-VEGF injection can control IOP effectively and be friendly to patients' BCVA without obvious serious complications throughout a 12-months follow-up period.

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Dataset Information

'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma.

Objectives

Design

Setting

Participants

Interventions

Outcome measures

Results

Conclusions

Publications

'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma.

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