Glaucoma Does Not Preclude Endocyclophotocoagulation Plus Phacoemulsification

Performing surgery
Doctor performing eye surgery in modern clinic
Even without a MIGS device, surgery-naive patients who underwent phaco-ECP can experience an IOP drop of 26%, a report suggests.

Patients with primary open-angle glaucoma (POAG) who have not had surgery experience lower intraocular pressure (IOP) and less reliance on topical therapies after endocyclophotocoagulation combined with phacoemulsification (phaco-ECP), according to a study published in Eye. The treatment is an option in addition to minimally invasive glaucoma surgery (MIGS) devices when considering cataract extraction with an IOP-lowering procedure.

In a retrospective case series, investigators examined 3 years worth of data from 83 eyes of 83 patients who received phaco-ECP. Before the procedure, the mean IOP for patients was 18.4±5.2 mm Hg, and the mean number of topical agents used by patients was 2.7±0.9. 

The participants’ mean IOP significantly dropped to 14.3±4.7 mm Hg at 1 year after the procedure, to 14.1±4.0 mm Hg 2 years later, and 13.6±3.7 mm Hg at 3 years (P <.0001). These changes continued for 70% of patients at year 1, 54% of patients at year 2, and 45% of patients at year 3. “This equated to a mean reduction of 4.1±5.6 mm Hg at 1 year (22%), 4.3±5.9 mm Hg at 2 years (23%) and 4.8±5.6 mm Hg at 3 years (26%),” the study says. These IOP gains continued for 70% of patients at year 1, 54% of patients at year 2, and 45% of patients at year 3.

The need for topical medications was also reduced to 1.3±1.2 at 1 year, 1.7±1.2 at 2 years, and 1.8±1.3 at 3 years (P <.0001). Some patients experienced complications, such as uveitis (6%), macular edema (2%), IOP spikes (1%), and corneal decompensation (1%); however, no patients experienced hypotony or retinal detachment.

“ECP is viewed by some as the original ‘MIGS’ procedure to lower IOP following cataract surgery,” the research says. In comparison, trabecular bypass implants can lower IOP by 9% using a single implant, and potentially 27% using 2 implants. Phacoemulsification alone can reduce IOP 4.7% at 12 months. ECP plus a double trabecular bypass stent can lower IOP 35% at 12 months, an improvement upon the combination of phaco and a stent, which can lower IOP 21%. The researchers report that they could not directly compare ECP-phaco due to changing trends in surgical management. Researchers say the ECP-phaco, without the use of implants and their associated risks, is safe and effective.

The study is limited by differences in study populations, failure criteria, thresholds for topical therapy use, lack of prospective randomized trials, and short follow-up periods, according to the researchers.

Disclosure: One of the study’s authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Yap TE, Zollet P, Husein S, et al. Endocyclophotocoagulation combined with phacoemulsification in surgically naive primary open-angle glaucoma: three-year results. Eye. Published online September 15, 2021. doi:10.1038/s41433-021-01734-4