Phacoemulsification Combined with Endoscopic Cyclophotocoagulation Vs Phacoemulsification Alone in Primary Angle Closure Glaucoma - a Randomised Controlled Trial.

PRECIS

Phacoemulsification combined with endoscopic cyclophotocoagulation had a statistically significant reduction in both intraocular pressure and number of medications as compared to Phacoemulsification alone.

PURPOSE

Comparative evaluation of Phacoemulsification combined with Endoscopic Cyclophotocoagulation (Phaco-ECP) Vs Phacoemulsification (Phaco) alone in primary angle closure glaucoma (PACG) with cataract.

DESIGN

Prospective, randomized, parallel group, active controlled trial.

PARTICIPANTS

Patients of PACG with cataract.

METHODS

A total of 100 consecutive patients with PACG and cataract were screened, of whom 66 patients meeting the inclusion criteria were recruited. Patients were randomized into 2 groups and underwent Phaco-ECP or Phaco alone. The patients were examined at baseline and at 1 week, 1 month, 3, 6, 12, 18 and 24 months. The anterior chamber angle parameters on swept-source anterior segment OCT (SS-ASOCT) were noted at baseline, and at 3, 6 and 12-months follow-up. Main Outcome Measures: The primary outcome measure was reduction in intraocular pressure (IOP) and the number of anti-glaucoma medications.

RESULTS

The mean baseline IOP was 19.9±5.8 mmHg and 19.5±7.2 mmHg in Phaco-ECP and Phaco groups, respectively (P=0.59). The mean IOP decreased to 14.0±2.6 mmHg and 15.7±2.2 mmHg at 24 months in Phaco-ECP and Phaco group, respectively (P=0.02). The reduction in number of medications was also significantly higher in Phaco-ECP group (1.8±1.10 mmHg vs. 1.0±0.8 mmHg; P=0.02) as compared to Phaco alone group. Qualified success with IOP ≤12 mmHg was obtained in 46.6% of patients in Phaco-ECP group and 13.7% of patients in Phaco group (P=0.01). No absolute failures (requirement of trabeculectomy) were noted in Phaco-ECP whereas 6.9% of patients had failure in Phaco group (P=0.23). A significant widening of the angle parameters was noted postoperatively at 3, 6, 12 and 18 months as compared to baseline in both the groups. The other secondary outcome parameters like BCVA, visual field changes, endothelial cell count, pupil diameter and complication rate were comparable between the groups.

CONCLUSIONS

Phaco-ECP group demonstrated a significant reduction in IOP and number of medications, along with a notable widening of nasal anterior chamber angle parameters as compared to Phaco alone group.