Comparison Of Trabeculectomy Versus Endoscopic Cyclophotocoagulation To Manage Cataract And Glaucoma

ObjectiveThis research was desighed to evaluate the effectiveness of trabeculectomy and endoscopic cyclophotocoagulation (ECP) which respectively combined with phacoemulsification and IOL implantation in the management of cataract and glaucoma. Through the comparation of the outcomes at different time point, the differences of the two different treatments are analysed which to guide the clinical application of ECP.MethodsRetrospective observation:47eyes of41patients with cataract and glaucoma who were consecutively recruited in Tianjin Medical University Eye Hospital from January to August,2013were divided into two groups by the operative mode. Trab group received trabeculectomy combined with phacoemulsification and IOL implantation while ECP group received endoscopic cyclophotocoagulation combined with phacoemulsification and IOL implantation. All procedures were performed by a single surgeon with rich clinical and surgery experiences.All patients were followed up at1day,1week,3week,1month and3months. The following data were collected: intraocular pressure (IOP), vision acuity, anti-glaucoma medications and complications during and after surgery. The Independent-Sample t Test was used to compare intraocular pressure (IOP) to study the therapeutic efficacy and safety of the operations.ResultsIOP:in Trab group,the rang of IOP before surgery was13.5～60mmHg (after using anti-glaucoma medications), the mean IOP was28.0±13.1mmHg; after surgery, the rang of IOP was6～16.7mmHg,and the mean IOP was11.3±2.8mmHg. in ECP group,the rang of IOP before surgery was12～60mmHg (after using anti-glaucoma medications), the mean IOP was28.0±13.1mmHg; after surgery, the rang of IOP was7.9-22mmHg,and the mean IOP was14.1±2.7mmHg.Compared to pre-operation, the IOP of post-operation was significantly decreased (P<0.01) at1day,1week,3weeks,1month and3months for both groups. Vision acuity:in Trab group, the vision acuity of19eyes(73.10%) was increased; the vision acuity of5eyes(19.23%) stayed at the same while2eyes(7.70%) was decreased; in ECP group, the vision acuity of16eyes(76.19%) was increased; the vision acuity of2yes(9.52%) stayed at the same while3eyes(14.29%) was decreased. During the procedures of all surgeries,there were no complications. After surgery, complications in ECP mainly included fibrous exudates in anterior chamber and IOP temporary increasing.The main complications in Trab group were conjunctival hyperemia and inflammation in anterior segment.ConclusionThe application of ECP combined with phacoemulsification and IOL implantation in glaucoma and cataract therapy is effective. The advantage of this procedure are as follows:minimal injuries, quick recovery, stable IOP lowering effects and less complications.Additionally, the long term efficicy should be further observed.