ECP is routinely added to Phacoemulsification for the treatment of mild to moderate glaucoma for long term IOP decrease and reduction or elimination of patient medications.

ECP combined with phacoemulsification cataract surgery is one of the most common indications for the procedure.  The cataract extraction is performed first, and the viscoelastic is removed from the capsular bag with irrigation / aspiration following intraocular lens implantation. The ciliary sulcus is then inflated and anterior chamber  expanded with a cohesive, sodium hyaluronate viscoelastic, creating a space between the lens and the iris. This iris bombay allows a clear view of and access to the heads of the ciliary processes.

The laser endoscope is then inserted into the cataract incision and the ciliary processes are in clear view.  Proper orientation of the image should be achieved prior to entering the eye.  The ideal distance from the tissue is realized when approximately 6 processes are in view.  The red aiming beam and laser power durations are set and treatment can begin.

270° - 360° of ciliary processes should be treated slowly and thoroughly, observing whitening and shrinking of the processes. The exposed valleys and all ciliary tissue should be treated. Undertreatment is the most common technique error for novices. "Popping" of the processes is an indication of overtreatment and should be avoided.

Three approaches can be taken to access the ciliary processes when combining ECP with cataract surgery.