Defining ECP

Endoscopic CylcoPhotocoagulation (ECP) describes the targeted treatment of the ciliary processes under direct visualization for the management of glaucoma. It is typically performed through a 19 or 20g ophthalmic laser microendoscope that offers video imaging, illumination and laser delivery. The surgeon is able to simultaneously view the processes on a video monitor and titrate treatment.

Endoscopic: Intraocular visualization

Cyclo: Circular pattern application

Photocoagulation: Light energy tissue ablation

Approaches and Surgical Techniques

There are various ways to approach the ciliary processes and many techniques that can be employed depending on lens status, type and severity of disease being treated. Here are some examples where ECP can be utilized:

Limbal / Cear Corneal Approach

Pars Plana Approach

Over the Bag

Through the Bag

Phakic Eye (Anterior Approach)

Aphakic Eye

Pseudophakic Eye

ECP Plus for Refractory Glaucoma

ECPL - Endocilioplasty for Plateau Iris Syndrome

ICE - Implant (MIGS), Cataract, ECP

ECP in Keratoproshthesis Glaucoma

Uveitis Glaucoma Hyphema Syndrome

Pseudoexfoliation Glaucoma

ECP for Cyclodialysis Cleft

The Basics of ECP

This animation illustrates the simple procedure of  Endoscopic CycloPhotocoagulation in an eye that has undergone phacoemulsification.

Background of ECP

Endoscopic CylcoPhotocoagulation (ECP) was first performed in 1992 and was developed as safe and effective alternative to TSCPC (transcleral cyclodestruction). The transcleral approach to cyclophotocoagulation is essentially a "blind" procedure, using high levels of laser energy and has an unacceptably high rate of chronic inflammation and complications. ECP is a targeted, precise and controlled approach to cyclophotocoagulation and over the years, through technique developement and clnical studies, ECP has proven its efficicacy and saftey profile. ECP is performed under direct visualization using an 810nm diode laser at approx. 250mw of energy.

Histopathology of Cyclodestructive Procedures

Histopathologic analysis comparing ECP to TSCPC was performed in three studies by Pantcheva el al, Lin et al and Alvarado (add references). The histological findings of the ECP-treated eyes contrasted with those of both the non-contact and contact TSCPC procedures.  In the ECP treated eyes, the cells displayed a regular and uniform and as well as an intact cell membrane and no discontinuities of the eptheliul bilayer. In contrast, the TSCPC treated eyes showed severe ciliary tissue damage and closure of many large and small blood vessels.


ECP is the most versitile glaucoma treatment and can be performed on most patients with glaucoma. It is most commonly performed at the time of cataract surgery for mild to moderate glaucoma but can be performed as a stand-alone procedure to treat more severe disease.

Contraindications and Cautions

Caution should be taken in patients with neovascular or uveitic glaucoma due to the possibility of severe inflammation or hypotony.

In patients with severe pseudoexfolation, white debris is often scattered over the surface of the ciliary processes so visible whitening and shrinking may not be apparent so caution should be taken to avoid overtreatment.

Light microscopy of transscleral cyclophoto-coagulation-treated tissue showing separation of the non-pigmented and pigmented ciliary epithelium (wavy arrow), pigment clumping (arrowheads), coagulative necrosis of the underlying ciliary stroma (asterisk) and architecturaldestruction of the treated tissue (straight arrows).

Light microscopy of endoscopic cyclophoto-coagulation-treated tissue showing loss of the lacy appearance of the ciliary processes (asterisk) with destruction of the non-pigmented epithelium and clumping of the pigmented epithelium (arrowheads).

A. Endoscopic view of ciliary processes in a pseudophakic eye.

B. Red aiming beam targets the processes to be treated.

C. Ciliary process shrink and whiten under direct photocoagulation.

Clinical Studies

  • Francis, B. A., Kwon, J., Fellman, R., et. al. Endoscopic ophthalmic surgery of the anterior segment. Survey of Ophthalmology. Vol 59, No.2 March 2014. 217-231.