Transscleral vs endoscopic cyclophotocoagulation: safety and efficacy when combined with phacoemulsification

Abstract Purpose To compare the effectiveness and safety of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco/ECP), phacoemulsification combined with MicroPulse transscleral cyclophotocoagulation (phaco/MP-TSCPC), and phacoemulsification alone (phaco) in the treatment of coexisting cataract and glaucoma. Methods Retrospective cohort study of consecutive cases at Massachusetts Eye & Ear. The main outcome measures were the cumulative probabilities of failure between the phaco/ECP group, phaco/MP-TSCPC group, and the phaco alone group with failure defined as reaching NLP vision at any point postoperatively or the inability to maintain ≥ 20% IOP reduction from baseline with IOP between 5–18 mmHg. Additional outcome measures included changes in average IOP, number of glaucoma medications, and complication rates. Results 64 eyes from 64 patients (25 phaco/ ECP, 20 phaco/ MPTSCPC, 19 phaco alone) were included in this study. The groups did not differ in age (mean 71.04 ± 6.7 years) or length of follow-up time. Primary open-angle glaucoma was the most common type of glaucoma in the phaco alone (42%) and phaco/ECP (48%) groups while mixed-mechanism glaucoma was the most common type in the phaco/MP-TSCPC group (40%). The mean IOP reductions at 1 year were 3.07 ± 5.3 mmHg from a baseline of 15.78 ± 4.7 in the phaco/ECP group, 6.0 ± 4.3 mmHg from a baseline of 18.37 ± 4.6 in the phaco/MP-TSCPC group and 1.0 ± 1.6 from a baseline of 14.30 ± 4.2 mmHg in the phaco alone group. Surgical failure was less likely in eyes in the phaco/MP-TSCPC and phaco/ECP groups compared to phaco alone based on the Kaplan-Meier survival criteria, with failure defined as the inability to maintain an IOP reduction of 20% or more with IOP between 5–18 mm Hg long term. There were no differences in complications among the three groups. Conclusions Phaco/MP-TSCPC appears to provide for greater long-term IOP control than phaco alone and phaco/ECP. All three procedures had similar safety profiles.