Cataract and Glaucoma Surgery: Endoscopic Cyclophotocoagulation versus Trabeculectomy.
PURPOSE
To compare the efficacy and safety of endoscopic cyclophotocoagulation (ECP) versus trabeculectomy with mitomycin C (trab) in combination with cataract surgery.


MATERIALS AND METHODS
We evaluated the 6-month results of patients undergoing phacoemulsification (phaco) with either ECP or trab. The primary outcome was mean intraocular pressure (IOP) at 6 months; secondary outcomes were change in glaucoma medications, visual acuity, intraocular inflammation, and postoperative complications. Complete success was a target IOP of <21 mmHg and >6 mmHg without glaucoma medications. Qualified success was target IOP achieved through glaucoma medications.


RESULTS
We evaluated 53 eyes of 53 patients; 24 (45.3%) eyes were treated with ECP-phaco and 29 (54.7%) with trab-phaco. At 6 months, there was no significant difference in mean IOP of the two groups (ECP-phaco 14.2 ± 3.6 mmHg; trab-phaco 13.0 ± 2.5 mmHg; P = 0.240). Six (25.0%) ECP-phaco eyes and 20 (69.0%) trab-phaco eyes achieved complete success (P = 0.002). Qualified success was achieved in 18 (75.0%) ECP-phaco eyes and 9 (31.0%) trab-phaco eyes (P = 0.002). The mean reduction of medication from baseline was significant (ECP-phaco 1.2 ± 1.1; trab-phaco 2.1 ± 1.5; P = 0.020). ECP-phaco resulted in more IOP spikes on the 1st postoperative day (P = 0.040) and more anterior cellular reaction at 1 week and 1 month compared to trab-phaco (P < 0.05). The rate of postoperative complications was not significantly different between groups.


CONCLUSION
At 6 months, ECP-phaco demonstrated similar improvements in IOP and visual acuity compared to trab-phaco. However, ECP-phaco patients had higher incidences of immediate postoperative IOP spikes and anterior chamber inflammation as well as requiring additional medications postoperatively.
['Marco|Sheila|S|', 'Damji|Karim F|KF|', 'Nazarali|Samir|S|', 'Rudnisky|Chris J|CJ|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000477:Alkylating Agents D002924:Ciliary Body D004724:Endoscopy D005260:Female D005901:Glaucoma D006801:Humans D007429:Intraocular Pressure D017075:Laser Coagulation D008297:Male D008875:Middle Aged D016685:Mitomycin D018918:Phacoemulsification D014065:Tonometry, Ocular D014130:Trabeculectomy D014792:Visual Acuity
glaucoma Endoscopic cyclophotocoagulation trabeculectomy