Long-term Surgical Outcomes of Phacoemulsification with Endoscopic Cyclophotocoagulation vs Phacoemulsification with Trabeculectomy and Mitomycin in Cataract and Glaucoma Patients

Purpose: To evaluate the long-term surgical outcomes of endoscopic cyclophotocoagulation (ECP) after four years follow-up in cataract and glaucoma patients that needed combined phacoemulsification and ECP (phaco-ECP) in comparison to combined phacoemulsification with trabeculectomy (phaco-trabeculectomy) with mitomycin C (MMC). Patients and Methods: Retrospective case-control study of 34 patients (34 eyes) with glaucoma who underwent phaco-ECP compared with phaco-trabeculectomy in tertiary eye specialist hospital in Saudi Arabia from 2010 to 2012. Participants were enrolled in two groups; ECP and trabeculectomy with MMC when combined with phacoemulsification. Success is defined as complete success when the IOP <= 21 mmHg without medication, qualified success when the IOP <= 21 mmHg with aid of topical medication. Results: Mean IOP decreased from 25.76 SD +/- 8.227 to 15.24 SD +/- 7.049 at last visit in phaco-trabeculectomy group and from 21.47 SD +/- 4.215 to 12.88 SD +/- 3.480 in phaco-ECP group. Mean medication use reduced from 2.89 SD +/- 0.3 preoperatively to 1.50 SD +/- 1.1 postoperatively (P<0.001) in phaco-trabeculectomy group. It reduced in phaco-ECP group from 2.24 SD +/- 0.8 preoperatively to 2.00 SD +/- 0.9 postoperatively, 35.3% of phaco-trabeculectomy group devel-oped vision-threatening complications while 0% in phaco-ECP group (P<0.001), 29.4% in phaco-trabeculectomy group required second surgical intervention compared to 17.6% in phaco-ECP group. In phaco-trabeculectomy group, 29.4% reached complete success, meanwhile in phaco-ECP group, 64.7% reached qualified success (P=0.026). Conclusion: ECP illustrates significant reduction of IOP and less postoperative complications if associated with phacoemulsification. Furthermore, it is safe and effective as a primary procedure alternative to combined cataract and trabeculectomy surgery for glaucoma patients having cataract and requiring surgical intervention.