The clinical efficacy of combining endoscopic cyclophotocoagulation (ECP) with cataract extraction in the therapeutic intervention for malignant glaucoma following trabeculectomy.

PURPOSE

This study aimed to observe the clinical efficacy of endoscopic cyclophotocoagulation (ECP) combined with cataract extraction in the management of malignant glaucoma.

METHODS

A total of 33 patients (34 eyes) who experienced malignant glaucoma following anti-glaucoma surgery at Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital) from January 2020 to January 2022 were selected. They were stratified into two groups: the ECP group (16 cases, 16 eyes) and the control group (15 cases, 16 eyes). The ECP group underwent ECP combined with cataract surgery, while the control group underwent anterior vitrectomy combined with cataract surgery. Various parameters, including visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), ciliary process thickness (CPT), ciliary process width (CPW), ciliary process area (CPA), iridociliary process contact length (ICPCL), and postoperative complications, were recorded and compared between the two groups.

RESULTS

There was no significant difference in preoperative basic conditions between the two groups. The patients were followed up for a duration ranging from 6 to 18 months. Both groups exhibited improved visual acuity after surgery, with no significant intergroup differences postoperatively (P > 0.05). Postoperative IOP in both groups decreased compared to preoperative levels, with the ECP group demonstrating a statistically significant lower IOP than the control group (t = 2.48, P < 0.05). ACD after surgery was significantly deeper in both groups compared to preoperative levels, with the ECP group showing a greater ACD than the control group (t = 2.14, P < 0.05). Postoperative CPT, CPW, CPA, and ICPCL in the ECP group were significantly reduced compared to preoperative values (P < 0.05), while no significant differences were observed in the control group before and after surgery. Early postoperative complications in both groups included anterior chamber inflammation, corneal edema, and Descemet membrane folds. In the long term, two eyes in both groups experienced increased IOP, requiring 1-2 types of IOP-lowering drugs to maintain IOP below 21 mmHg. Choroidal detachment occurred in one eye in the control group. No serious complications, such as corneal endothelial decompensation, intraocular hemorrhage, infection, or uncontrolled intraocular pressure, were reported.

CONCLUSIONS

The combination of ECP and cataract extraction proves to be a safe and effective therapeutic approach for managing malignant glaucoma following anti-glaucoma surgery.