Outcomes of phaco-endocyclophotocoagulation in acute on chronic primary angle closure glaucoma

PURPOSE: To report the outcomes of endocyclophotocoagulation (ECP) combined with phacoemulsification in primary angle closure glaucoma (PACG) eyes presenting with acute symptoms (A-o-C-PACG) and to compare the biometric characteristics of these eyes with PACG controls. METHODS: Retrospective data collection of consecutive PACG subjects presenting with symptoms of acute angle closure between May 2021 and September 2023. Such subjects were compared to severity-of-glaucoma-matched PACG controls. Only those eyes that underwent phaco-ECP were included. The main outcome measure was intraocular pressure (IOP) and a comparison of biometric parameters between cases and controls. The secondary outcome measures were the number of anti-glaucoma medications (AGMs), best-corrected visual acuity (BCVA), and complications. RESULTS: Fifteen study eyes and 26 PACG controls were included; the mean age was 54.2 ± 7.4 years. The mean IOP (34.6 ± 13.4 mmHg, 95%CI [27.2,42.0]), AGM (4.3 ± 1.2,95%CI [3.6,5.0]), synechial angle closure (3.3 ± 1.0 quadrants, 95%CI [2.7,3.8]), and lens thickness (5.1 ± 0.3, 95%CI [4.9,5.3]) were significantly more, and the anterior chamber depth (2.3 ± 0.3 mm, 95%CI [2.1,2.5]) and relative lens position (0.20 ± 0.01, 95%CI [0.19,0.20]) were significantly less when compared to PACG controls. IOP at the last follow-up postprocedure (mean 18 months) was 12.7 ± 2.3 mmHg, 95%CI [11.4,13.9] on 0.7 ± 0.8, 95%CI [0.2, 1.1], number of AGM ( P < .001). BCVA improved significantly from 0.9 ± 0.7, 95%CI [0.5,1.3], to 0.2 ± 0.3, 95%CI [0.03,0.4]; none had serious sight-threatening complications. CONCLUSION: Phaco-endocyclophotocoagulation is not only effective but also very safe in controlling IOP and reducing topical medications in PACG eyes that present with acute symptoms. Biometric parameters are significantly different in such eyes when compared to PACG controls.