Phacoemulsification with endoscopic cyclophotocoagulation lowers IOP and medication needs versus phaco alone in PACG with cataractCombined glaucoma and cataract surgery shows modest pressure benefit in small study

PRECIS: Phacoemulsification combined with endoscopic cyclophotocoagulation had a statistically significant reduction in both intraocular pressure and the number of medications compared with phacoemulsification alone. PURPOSE: Comparative evaluation of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco-ECP) versus phacoemulsification (phaco) alone in primary angle closure glaucoma (PACG) with cataract. DESIGN: Prospective, randomized, parallel-group, active-controlled trial. PARTICIPANTS: Patients with PACG and cataract. METHODS: A total of 100 consecutive patients with PACG and cataract were screened, of whom 66 patients who met 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, 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 the 3-, 6-, and 12-month follow-up. The primary outcome measures were reduction in intraocular pressure (IOP) and the number of antiglaucoma medications. RESULTS: The mean baseline IOP was 19.9±5.8 and 19.5±7.2 mm Hg in the phaco-ECP and phaco groups, respectively ( P =0.59). The mean IOP decreased to 14.0±2.6 and 15.7±2.2 mm Hg at 24 months in the phaco-ECP and phaco group, respectively ( P =0.02). The reduction in the number of medications was also significantly higher in the phaco-ECP group (1.8±1.10 vs. 1.0±0.8 mm Hg; P =0.02) as compared with the phaco-alone group. Qualified success with IOP ≤12 mm Hg was obtained in 46.6% of patients in the phaco-ECP group and 13.7% of patients in the Phaco group ( P =0.01). No absolute failures (requiring trabeculectomy) were noted in the phaco-ECP, whereas 6.9% of patients in the phaco group failed ( P =0.23). A significant widening of the angle parameters was noted postoperatively at 3, 6, 12, and 18 months as compared with baseline in both 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: The phaco-ECP group demonstrated a significant reduction in IOP and the number of medications, along with a notable widening of the nasal anterior chamber angle parameters compared with the phaco-alone group.