Combined Procedures Achieve Superior IOP Reduction in Angle Closure Patients

Researchers compare IOPs of patients who underwent combined phacoemulsification-endoscopic cyclophotocoagulation and phacoemulsification alone.

Combining phacoemulsification-endoscopic cyclophotocoagulation (phaco-ECP) to treat primary angle-closure glaucoma (PACG) and cataracts resulted in statistically significant greater intraocular pressure (IOP) reduction at 12- and 24-month follow-up than phaco alone, but both procedures reduced dependence on glaucoma drugs and had a comparable safety profile, according to a study published in Ophthalmology Glaucoma.

The prospective randomized controlled clinical trial pilot study included 48 PACG eyes with coexisting cataract in 48 patients who were randomized into undergoing phaco- (27 eyes) or phaco alone (21 eyes). Patients were followed every 3 months for 2 years.

The main outcome measures were IOP and the requirement for topical glaucoma drugs.

No statistically significant difference was found in mean preoperative IOP between phaco-ECP and phaco groups (20.0 mm Hg vs 20.7 mm Hg, P =.71), but phaco-ECP did lower mean postoperative IOP at 12 months vs phaco alone (14.3 mm Hg vs 16.6 mm Hg, P =.01, respectively) and at 24 months (14.5 mm Hg vs 16.3 mm Hg, P =.04, respectively). Mean number of glaucoma drugs was reduced 3.3 to 1.7 (P <.01) in the phaco-ECP group, and from 3.1 to 2.1 (P <.01) in the phaco only group, at 24 months.

The groups displayed comparable results in visual improvement, complication rate, need for additional surgical intervention, and visual field changes.

“Combined phaco-ECP is non-inferior to phacoemulsification alone in controlling IOP in PACG eyes with cataract,” according to investigators. “In our pilot study, combined phaco-ECP achieved a statistically significant greater IOP reduction than phacoemulsification alone at 12 and 24 months of follow up. However, further studies are required to evaluate the actual clinical benefit of adjunctive ECP during cataract extraction on long-term glaucoma progression and visual loss.”

The study’s limitations include the fact that the study had 5 surgeons, who might’ve used slight variations in their surgical techniques; investigators weren’t able to standardize the type of anesthesia used, which could’ve impacted clinical outcomes; the sample size and follow-up time weren’t sufficient to examine outcomes like glaucomatous visual field progression; and finally, there are “overlaps between the upper and lower limits of the confidence intervals in the IOP measurement across various time points.”


Lai I, Chan N, Ling A, et al. Combined phacoemulsification-endoscopic cyclophotocoagulation versus phacoemulsification alone in primary angle-closure glaucoma: a randomized controlled trial pilot study. Ophthalmol Glaucoma. Published online March 12, 2021. doi:10.1016/j.ogla.2021.03.007.