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‘Phaco–ECP’: combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma
  1. Dan Lindfield1,
  2. Robert W Ritchie2,
  3. Michael FP Griffiths1
  1. 1Department of Ophthalmology, Frimley Park Hospital, Camberley, UK
  2. 2Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Dan Lindfield; drdanlindfield{at}gmail.com

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.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • To cite: Lindfield D, Ritchie RW, Griffiths MFP, et al. ‘Phaco-ECP’: combined endoscopic cyclophotocoagulation (ECP) and cataract surgery to augment medical control of glaucoma. BMJ Open 2012;2:e000578. doi:10.1136/bmjopen-2011-000578

  • Contributors DL conceived, designed and acquired the data, drafted the article and approved the final manuscript. RWR analysed and interpreted the data, revised the manuscript and approved the final version. MFPG was involved in the conception of the article, revising the manuscript and its final approval.

  • Competing interests None.

  • Ethics approval Retrospective audit of current standard practice.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

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