Combined phacoemulsification, endoscopic ciliary process photocoagulation, and intraocular lens implantation in glaucoma management.

The safety and efficacy of combined cataract extraction and intraocular lens (IOL) implantation with endoscopic ciliary process photocoagulation in glaucoma management was evaluated. Ten patients with uncontrolled open-angle glaucoma and cataract prospectively underwent concomitant phacoemulsification, endoscopic ciliary process photocoagulation, and posterior chamber IOL implantation. With a mean follow up of 19.2 months, the mean intraocular pressure (IOP) decreased from 31.4 mm Hg preoperatively to 13.5 mm Hg postoperatively, an absolute decrease of 57%. This represented a significant decrease for each of the patients. The visual acuity of each also improved. Transient vitreous hemorrhage developed in one patient, but no cystoid macular edema or any other significant complications occurred and all eyes were quiet. There were no lens implant dislocations. There was no progressive visual field loss at 1 month post surgery, but such loss was noted in one patient 1 year after treatment. Good IOP control on no medical therapy was attained in one half of the patients. It may be concluded that this combined procedure provided effective management of cataract and glaucoma with a minimum of postoperative care. The safety and efficacy of this approach as compared with cataract surgery combined with filtration remains to be determined.