Efficacy and safety of combined trans-scleral cyclophotocoagulation (TSCPC) and phacoemulsification surgery

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Abstract

Purpose

To assess the effect of combined TSCPC and phaco+IOL with respect to; a) IOP; b) VA; c) topical therapy d) side effect profile at 6 months post surgery.

Methods

A retrospective review of 24 eyes undergoing combined TSCPC and phacoemulsification was conducted at 6 months post-operatively. The procedures were performed by one surgeon (EA) under peribulbar local anaesthesia. TSCPC was applied across 270 degrees after completion of phaco+IOL. Subtenons Triamcinolone Acetonide 40mg was administered after each case. G. Prednisolone 1% x6 daily was used post-operatively for 6 weeks. The patients were reviewed at weeks 1, 4, 12 and 24.

Results

24 eyes were included. 20 had open angle glaucoma, 3 had mixed mechanism glaucoma and 1 neovascular glaucoma (NVG). The average total energy used was 87.5W, (Range: 33.8-346W). Mean pre-treatment IOP was 22.1mmHg (Range 12-47mmHg) and mean IOP at 6 months post treatment was 14mmHg (Range 0-20mmHg);(p<0.05). Mean total medication was reduced from 2.1 to 1.9;(p=0.55). Diamox was discontinued in all 7 cases who were taking this pre-operatively. VA was stable or improved in 18 eyes (76%) and worse in 6 eyes (25%). Uveitis occurred in 5 eyes following treatment, 1 patient developed optic atrophy and chronic hypotony occurred in only 1 eye which had NVG. The causes of worsening of visual acuity at 6 months were chronic hypotony (n=1), chronic cystoid macular oedema (n=2), worsening of glaucoma (n=3).

Conclusion

Combined TSCPC and phacoemulsification is effective in treating cataract and glaucoma. Post-operative inflammation is a potential threat to visual improvement.

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