Endoscopic cyclophotocoagulation (ECP) is a laser treatment performed during cataract surgery to lower intraocular pressure in patients with glaucoma. ECP involves using an endoscope to view and treat the ciliary processes with an infrared laser. A study compared outcomes of 707 patients who received phacoemulsification with ECP versus phacoemulsification alone. At 3 years post-op, the ECP group used fewer glaucoma medications and had lower IOP compared to the phacoemulsification alone group. No serious complications occurred. ECP during cataract surgery is an effective treatment that lowers IOP, reduces medication use, and has minimal risks.

1. Endoscopic
CycloPhotocoagulation
Martin Uram MD, MPH

2. Laser Endoscope
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

3. E2 Laser and Endoscopy System
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

4. 4 Skills for ECP
⇒Watching Video Monitor
⇒Accessing ciliary procesesses given
approach and lens status
⇒Inflating ciliary sulcus
⇒Controlling long duration, invisible
wavelength laser
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

5. Anesthesia
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

6. Incision
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

7. ECP Treatment
Principle
⇒ LENS BEHIND IRIS:
VISCOELASTIC
⇒ SINGLE CHAMBER EYE:
INFUSION
AVOID HYPOTONY
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

8. Inflating the Ciliary
Sulcus
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

9. Combined Procedures:
Limbal, Over Bag / PC-IOL
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

10. No PPL for Phakic Eyes
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

11. Curved Probe, Limbal
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

12. Desired Tissue Effect
⇒Whiten ciliary
processes
⇒Shrink ciliary
processes
⇒Treat entire
ciliary process
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

13. Inflating the Ciliary
Sulcus
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

14. Complete Treatment
INADEQUATE TREATMENT
RESULTS IN:
⇒ POOR IOP CONTROL
⇒ ONLY TEMPORARY “GOOD” RESULT
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

15. Treatment Zone
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

16. ECP: Post-Op
Meds
⇒ SAME AS PHACO ALONE
⇒ IOP SPIKE PROPHYLAXIS
⇒ PARACENTESIS
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

17. ECP COLLABORATIVE STUDY
GROUP
5824 PATIENTS
COMPLICATIONS
IOP Spike 14.5%
Hemorrhage 3.8%
Serous Choroidal Effusion 0.36%
IOL Dislocation 0.36%
CME 1.03%
RD 0.27%
Massive Choroidal Hemorrhage 0.09%
Hypotony or Phthisis 0.12%
NLP Vision 0.12%
Cataract 24.5%
Acute Graft Rejection 5.3%
Chronic Graft Rejection 0
Chronic Inflammation 0
Flat AC 0
Endophthalmitis 0
Diplopia 0
Wound Leak 0
Bleb Complications 0

18. Phaco-ECP vs Phaco
Alone
Stanley J. Berke, M.D., FACS, et. al..
 707 Patients
 626 Randomized to Phaco-ECP Group
 81 Randomized to Phaco Alone
 5 Surgeons
 Parameters such as VA, IOP, Meds, &
complications were
followed
 Mean follow-up was 3.2 years (0.5 to 5.8 years)
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

19. Phaco-ECP vs Phaco Alone
Pre-op Post-op P Pre-op Post-op P
IOP IOP Meds Meds
mmHg mmHg (#) (#)
Phaco- 19.08 15.73 4.48 1.53 0.65 1.23
ECP ± ± X ± ± X
4.14 3.00 10 -72 0.89 0.95 10 -85
Phaco 18.16 18.93 1.20 1.20
Alone ± ± .01 ± ± 0.50
3.38 4.12 0.83 0.87
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

20. Phaco-ECP vs Phaco Alone:
Medications at End of Follow-Up
Phaco-ECP Phaco Alone
11%
27%
12%
68% 5% 77%
no change increase decrease

21. Phaco-ECP vs Phaco Alone:
Post-Op IOP Change
Phaco-ECP Phaco Alone
2%
IOP
9%
12%
38%
79% 60%
no change increase decrease

22. Phaco-ECP vs Phaco Alone:
Mean IOP Over Time
20
1.53 Meds Phaco-ECP
mmHg
Phaco Alone
19
1.20 Meds
18
1.20 Meds
17
16 0.65 Meds
15
14 Pre-Op 6 Months 1 Year 2 Years 3 Years
Phaco-ECP 19.08 16.03 16.14 16.09 16.03
Phaco Alone 18.16 17.62 16.28 16.87 18.93

23. Phaco-ECP vs Phaco Alone
Complications
No serious complications
were reported in either group
1 patient in each group
developed CME

24. Phaco-ECP vs Phaco Alone
Glaucoma Medication Cost Analysis
Pre-Op Post-Op Savings/Loss
Phaco-ECP monthly patient cost $220.08 $94.78 $125.30
Phaco-ECP annual patient cost $2,640.92 $1,137.35 $1,503.57
Phaco Alone monthly patient cost $144.45 $160.28 ($15.83)
Phaco Alone annual patient cost $1,733.40 $1,923.36 ($189.96)
Estimated US annual savings* $846,765,000
* 2.5 million cataract procedures annually. 20% of cataract surgery patients
concurrently treated with glaucoma medications.

25. Phaco-ECP:
Conclusion
⇒ Hard to get in trouble
⇒ It usually works
⇒ It’s fun!