Comparative Study: Phaco with Micropulse Cyclophotocoagulation vs Phaco with Endoscopic Cyclophotocoagulation.

BACKGROUND AND OBJECTIVES: Glaucoma is a leading cause of irreversible blindness, primarily managed by lowering intraocular pressure (IOP). In individuals with both cataract and glaucoma, phacoemulsification alone can substantially reduce IOP. However, to achieve better pressure control, combining cataract surgery with cyclophotocoagulation has gained attention as an effective approach. Among the available methods, micropulse transscleral cyclophotocoagulation (MP-TCP) and endoscopic cyclophotocoagulation (ECP) represent two techniques that target the ciliary body through distinct mechanisms, differing in their level of invasiveness and therapeutic outcomes. The objective of this study is to evaluate the safety and efficacy of phacoemulsification combined with MP-TCP compared with phacoemulsification combined with ECP in patients presenting with both cataract and glaucoma. MATERIALS AND METHODS: In this randomized trial-based study, adults aged 40-80 years undergoing cataract surgery with glaucoma were enrolled and randomized to receive either phaco + MP-TCP or phaco + ECP. Primary outcomes included variations in IOP, several IOP-lowering therapeutics, clarity of vision [logMAR (minimum angle of resolution)], and complications observed over 12 months postoperative follow-up. RESULTS: Baseline characteristics were comparable between ECP (24 eyes) and MP-TCP (15 eyes) groups. Both interventions significantly reduced IOP over time, with the endoscope group showing greater early reductions at 1 week and 3 months, although differences were no longer significant by 6 and 12 months. Medication burden decreased in both groups, with MP demonstrating a greater reduction at 1 week but no significant differences afterward. Visual acuity improved similarly across both treatments throughout follow-up. Complication rates were low and comparable (20.8 vs 21.4%). Overall, endoscopic treatment achieved larger early IOP reductions, while long-term outcomes, including IOP control, medication use, visual acuity, and safety, were similar between the two interventions. CONCLUSION: Both phaco + MP-TCP and phaco + ECP are effective, safe surgical options for managing glaucoma in patients undergoing cataract surgery. ECP offers superior early IOP reduction, whereas MP-TCP more effectively reduces medication dependence. The choice of technique should be tailored to individual clinical priorities. CLINICAL SIGNIFICANCE: Phaco + MP-TCP and phaco + ECP are safe and efficacious options for patients with coexisting cataract and glaucoma, with ECP providing greater early IOP reduction and MP-TCP offering sustained medication burden relief. The choice of procedure should be individualized based on patient priorities and clinical needs.