Long-term Outcome Of Combined Glaucoma Cataract Surgery With Endoscopic Cyclophotocoagulation Vs Trabeculectomy

Objective:A retrospective study of micro-incision(2.2mm)cataract phacoemulsification and intraocular lens implantation(IOL)combined with endoscopic cyclophotocoagulation(ECP)was performed to observe the long-term clinical efficacy and safety in the treatment of patients with primary glaucoma and cataract,and compared with micro-incision cataract phacoemulsification and IOL implantation combined with compound trabeculectomy(Trab).Methods:From January 2016 to August 2016,50 patients(60 eyes)with primary glaucoma and cataract who were admitted to Tianjin Medical University Eye Hospital were retrospectively observed and analyzed.24 patients(30 eyes)underwent micro-incision(2.2mm)cataract surgery combined with ECP(phaco-ECP group).26patients(30 eyes)with micro-incision cataract surgery combined with Trab(phaco-Trab group)were the control group.All the surgeries were performed by an experienced ophthalmologist.The long-term(36 months)intraocular pressure(IOP),best corrected visual acuity,corneal endothelial count,central visual field,retinal nerve fiber layer(RNFL)thickness,use of IOP-lowering drugs and postoperative complications were copmpared inter-and intra-grouply.Statistical methods including t-test,x 2 test,repeated measurement analysis of variance were used to analyze the long-term outcome of combined glaucoma cataract surgery with ECP vs Trab.Results:1.IOP: Except at the first postoperative day,IOP of the phaco-ECP group at other follow-up time was lower than that before the operation.IOP of the phaco-Trab group at all follow-up time was lower than that before the operation,and both difference was statistically significant(P <0.001).Between the two groups,the difference in IOP before surgery was not statistically significant(P> 0.05),but within 6 months after surgery,the difference in IOP was statistically significant(P <0.05).2.Visual acuity(VA): The VA of the two groups at 36 months after operation was significantly improved compared with that before the operation,and the differencewas statistically significant(P <0.001).Before and after the operation,there was no statistically significant difference in VA between the two groups(P> 0.05).3.Corneal endothelial cell count: Before and after the operation,there was no statistically significant difference in corneal endothelial cell count between the two groups(P> 0.05);but compared with preoperative period,the number of corneal endothelial cells in both groups decreased significantly at 36 months after surgery.4.Central visual field: Before and after the operation,MD and PSD between the two groups were not statistically significant(P> 0.05).Compared with the preoperative period,MD and PSD of the two groups were not statistically different after surgery.5.RNFL thickness: The RNFL thickness of the two groups decreased significantly at36 months after surgery,and the difference was statistically significant(P <0.001).Before and after surgery,there was no statistically significant difference in the thickness of RNFL between the two groups(P> 0.05).6.Postoperative complications: Postoperative complications of phaco-ECP group(20%),including transient high IOP and anterior chamber fibrous exudation,was less than phaco-Trab group(26.7 %),including shallow anterior chamber,fibrous exudation in the anterior chamber,filtration bubble leakage,low IOP.7.The use of IOP-lowering drugs and the complete success rate of surgery: The difference in the use of IOP-lowering drugs between the two groups before and after surgery was statistically significant(P<0.05).There was no significant difference in the complete success rate between the two groups(P> 0.05).Conclusions:The long-term outcome of phaco-ECP and phaco-Trab in the treatment of primary glaucoma and cataract are great and similar.They can both effectively reduce IOP,improve vision,delay visual field damage,and reduce the use of IOP-lowering drugs.phaco-ECP has fewer postoperative complicationsis and safer than phaco-Trab.phaco-ECP is another safe and effective option for the treatment of primary glaucoma and cataract.