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@#AIM: To analyze the clinical value of phacoemulsification and intraocular lens implantation(Phaco+IOL)combined with endoscopic cyclophotocoagulation(ECP)in the treatment of patients with glaucoma and cataract. <p>METHODS: Between January and December 2019, 58 patients(64 eyes)with primary glaucoma and cataract diagnosed and treated in Ophthalmology Department of the hospital were enrolled in this study. According to the patients' and their family members' willingness, the study subjects were divided into ECP group(27 cases, 30 eyes, Phaco+IOL+ECP)and trabeculectomy(TRAB)group(31 cases, 34 eyes, Phaco+IOL+TRAB). Surgical results, changes in visual acuity, intraocular pressure, corneal endothelial cells, and optical coherence tomography(OCT)parameter were compared between the two groups. <p>RESULTS: The complete success rate of surgery in ECP group was 83%, higher than 59% in TRAB group(<i>P</i><0.05). After surgery, visual acuity of the two groups was improved, and intraocular pressure was reduced(<i>P</i><0.05), without statistical difference between groups(<i>P</i>>0.05). After surgery, the coefficient of variation of corneal endothelial area, proportion of hexagonal cells, average cellular area, and central corneal thickness of ECP group were lower and smaller than those of TRAB group, while corneal endothelial cell density was higher than TRAB group(<i>P</i><0.05). After surgery, anterior chamber depth(ACD), angular opening distance 500(AOD<sub>500</sub>), trabecular iris angle(TIA), and angular recess area(ARA)were increased in the two groups(<i>P</i><0.05), without statistically significant differences between groups(<i>P</i>>0.05). The incidence of ocular hypertension requiring drug control and the total incidence of ocular hypertension were significantly lower in ECP group than in TRAB group(all <i>P</i><0.05). <p>CONCLUSION: Compared with TRAB, ECP can achieve a higher complete success rate in the treatment of glaucoma with cataract, with less influence on corneal cells.
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Objective To evaluate the efficacy of ECP and glaucoma drainage device implant in the management of refractory glaucoma. Methods A retrospective study was explored in refractory glaucoma in 99 eyes,in which there were 50 eyes in the ECP group(group A)and 49 eyes in the group of glaucoma drainage device implant (group B). The changes of intraocular pressure (IOP),visual acuity and complication were observed. Results (1)IOP:There was statistically significant difference in IOP between the preoperative and last follow-up in each group(T-Test,t = 2.47,t = 2.51,P 0.05).(3)Complication:The early complications of the group A included anterior chamber exudation ,short-term high IOP,hyphema. In the group B,the early complications included shallow anterior chamber,hyphema, drainage valve block and high IOP,MSCH,choroidal detachment,while the medium-term complication was glaucoma valve fiber wrapped high IOP and the long-term complications included glaucoma drainage tube rejection , exposure and displacement,and endophthalmitis,conjunctival hyperplasia. Conclusion ECP and glaucoma drainage implant can be effective in the treatment of refractory glaucoma. The ECP has less complications.
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Su rgical treatment of glaucoma has been classified as cyclodestructive(reducing inflow)or filtering(increasing outflow).Cyclodestructive procedures have traditionally been reserved for eyes with poor visual prognoses and refractory glaucomas including post-trauma,aphakia,congenital and developmental glaucoma.Since Uram described the first use of endoscopic cyclophotocoa gulation(ECP)in 1992,short and long-term outcomes for ECP have been promising.In the present article,we conduct a Pubmed search and review of published English Iiterature on endoscopic cyclophotocoagulation and comparison with limited results in a single Singapore ophthalmic tertiary hospital.Safety and efficacy of ECP and combined phacoemulsification-ECP procedures in treatment of pediatric and adult glaucomas of various etiologies and severities is reported.Local short-term unpublished results from a single Singapore tertiary ophthalmic service is reported and concurs with previously published results.Published reports and current experience with ECP has demonstrated that ECP with direct visualization of the target tissues avoids the complications associated with blind'trans-scleral cyclophotocoagulation by applying optimum energy to target tissue ciliary epithelium with endoscopic visualization and infrared laser wavelength application.Significant financial barriers exist to introducing this service.It is safe and effective in controlling IOP and reducing reliance on anti-glaucoma medications.Wide spread acceptance and use of this technique awaits large scale randomized controlled studies.