Phaco-endocyclophotocoagulation versus phaco-trabeculectomy in advanced glaucoma: A pilot study

Purpose: To investigate the safety and efficacy of combining minimally invasive glaucoma surgery (MIGS) endocyclophotocoagulation (ECP) in advanced primary glaucomas and compare them with those of the current gold standard of phaco-trabeculectomy (PT). Methods: This is a retrospective study of subjects with advanced primary glaucomas (primary open angle glaucoma and primary angle closure glaucoma), more than 30 years, and who underwent ECP or trabeculectomy with Mitomycin C along with phaco-surgery. The primary outcome measure was IOP. The secondary outcomes were the number of anti-glaucoma medications (AGMs), best corrected visual acuity (BCVA), total success (defined as complete and qualified), complications, and interventions for these. Results: Twenty-eight eyes with phaco-ECP and a mean follow-up of 18 months were compared to 24 eyes that underwent PT (mean follow-up of 16 months). IOP reduced from 24.9 ± 12.9 to 14.0 ± 2.3 mmHg in the former group, and from 26.7 ± 8.7 to 13.7 ± 3.0 mmHg in the latter ( p =.667); AGM was reduced from 3.6 ± 1.0 to 0.9 ± 1.0 and 3.5 ± 1.1 to 1.4 ± 1.5 in each group, respectively ( p =.624). No sight-threatening complications occurred in either group; however, BCVA improved significantly in the phaco-ECP group ( p =.04). Though complications were more in the PT group, and so were the interventions (excluding suturelysis) they were marginally short of reaching significance ( p =.05). No loss of vision occurred in either group. There were two failures in the PT group. Conclusion: Combining ECP with phaco has the potential to be as effective as the current gold standard in advanced primary glaucomas. It is safer with significantly improved BCVA and a much-reduced need for any interventions. Larger studies and longer follow-ups are recommended.