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'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma.

Lindfield D, Ritchie RW, Griffiths MF - BMJ Open (2012)

Bottom Line: Is phaco-ECP safe?Statistically significant decrease in IOP was demonstrated at all time points (p<0.001).This study confirms the safety of phaco-ECP.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Frimley Park Hospital, Camberley, UK.

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.

No MeSH data available.


Related in: MedlinePlus

Medications over time.
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Related In: Results  -  Collection

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fig3: Medications over time.

Mentions: The analysis of intraocular pressure-lowering medications at each time point is shown in table 2 and is demonstrated graphically in figure 3. The number shown represents the number of topical IOP-lowering agents not the number of bottles used. For example, fixed prostaglandin and β blocker combinations were recorded as two medications. Preoperative mean medication usage was 1.97 agents (95% CI 0.28). At 18 and 24 months, respectively, the mean number of topical agents was 1.96 (95% CI 0.26) and 2.07 (95% CI 0.31), with no statistically significant change in agent use compared with pre-treatment. No patients (0%) received oral or intravenous acetazolamide at any point.


'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma.

Lindfield D, Ritchie RW, Griffiths MF - BMJ Open (2012)

Medications over time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3367146&req=5

fig3: Medications over time.
Mentions: The analysis of intraocular pressure-lowering medications at each time point is shown in table 2 and is demonstrated graphically in figure 3. The number shown represents the number of topical IOP-lowering agents not the number of bottles used. For example, fixed prostaglandin and β blocker combinations were recorded as two medications. Preoperative mean medication usage was 1.97 agents (95% CI 0.28). At 18 and 24 months, respectively, the mean number of topical agents was 1.96 (95% CI 0.26) and 2.07 (95% CI 0.31), with no statistically significant change in agent use compared with pre-treatment. No patients (0%) received oral or intravenous acetazolamide at any point.

Bottom Line: Is phaco-ECP safe?Statistically significant decrease in IOP was demonstrated at all time points (p<0.001).This study confirms the safety of phaco-ECP.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Frimley Park Hospital, Camberley, UK.

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.

No MeSH data available.


Related in: MedlinePlus