The Effect of Endoscopic Cyclophotocoagulation on the Outcomes of Excisional Goniotomy with and without Phacoemulsification.

Precis: Combination MIGS procedures are a potentially more efficacious method to decrease mean IOP and glaucoma medication burden; however, our findings question whether the addition of ECP to excisional goniotomy provides significant additional benefit.

Purpose: Combined microinvasive glaucoma surgery (MIGS) procedures are gaining popularity. While the individual efficacy of excisional goniotomy and endoscopic cyclophotocoagulation (ECP) is well established, data supporting their use in combination is lacking. Our study aims to evaluate the additive benefit of ECP to excisional goniotomy with the Kahook Dual Blade (KDB) in the largest patient cohort evaluated to date.

Materials: and Methods: A retrospective chart review was performed of adults seen at a tertiary eye center between May 2015 and August 2019. Patients who received goniotomy alone were compared to those who received standalone goniotomy and ECP (KDB/ECP), while those who received goniotomy and phacoemulsification (KDB/phaco) were compared to those undergoing phacoemulsification, goniotomy and ECP (PEcK).

Results: A total of 723 eyes were included. All four study groups had a decrease in mean IOP at 6, 12, and 24 months (all P<0.05) and a significant decrease in glaucoma medications at 12 months (all P<0.05). When comparing the KDB group to the KDB/ECP group, there were no statistical differences in mean IOP or number of glaucoma medications at any timepoint (P>0.05 for all). When comparing the KDB/phaco group to the PEcK group there were no statistical differences in mean IOP (P>0.05 for all) or glaucoma medications at 12 and 24 months.

Conclusion: Both standalone KDB goniotomy with ECP and the PEcK procedure are efficacious at lowering IOP and glaucoma medication burden. While success rates were not improved, the addition of ECP to KDB goniotomy appears to achieve a more sustained reduction in medication burden compared to goniotomy alone.