ECP and ECP Plus for Refractory and Advanced Glaucoma
For more dramatic IOP reduction, advanced disease can be treated with ECP and ECP Plus (ECP+) . The pars plana approach is used for ECP+ so is ideal for eyes with anterior chamber pathology, but cannot be used in Phakic patients.
Technique
The ECP+ technique was first described by Franciso Lima in 2004 where he compared ECP to the Ahmed Drainage Implant in the treatment of Refractory Glaucoma. A pars plana incision was made 3.5mm from the limbus and 210° of ciliary processes were treated using a 20g straight laser microendoscope. Scleral depression was used to access the entirety of ciliary processes. Following the ECP, the anterior third of the pars plana was treated.
A more typical approach is to treat a full 360° of the ciliary process followed by a confluent layer of treatment on the pars plana.
Clinical Efficacy
In 2009 Spaeth and Uram evaluted the safey and efficacy of ECP in 17 eyes of 12 patients who had failed an average of 2.5 prior glaucoma surgeries and were at MMT. Mean follow-up time was 2-17 months. Mean pre-op IOP was 27.9mmHg mean pre-op meds were 3.76. Mean post-op IOP was 10.53mmHg and mean post-op meds was 0.94.
In 2015, Francis, et. al. treated between 300° and 330° of ECP+ on 53 eyes who had uncontrolled IOP despite prior glaucoma surgeries and MMT. Main outcomes were measured at 6 and 12 months. Mean pre-op IOP was 27.9 mmHg and mean pre-op meds was 3.4. Post-op IOP was 15.3 mmHg and post-op meds 0.7.
360° of treated ciliary processes from the pars plana. A confluent row is treated. Scleral depression offers access to untreated valleys between the ciliary processes.
Endoscopic views of treated ciliary processes and pars plana.
Videos
ECP+ for Refractory Glaucoma
Stanley Berke, MD, FACS, explains the process and benefits of performing Endoscopic Cyclophotocoagulation (ECP) during the cataract procedure after phacoemulsification is complete... (Awaiting Copy)
ECP+ Treatment from a Second Incision
Stanley Berke, MD, FACS, explains the process and benefits of performing Endoscopic Cyclophotocoagulation (ECP) during the cataract procedure after phacoemulsification is complete... (Awaiting Copy)
Articles
ECP in Refractory Glaucoma Patients.
Glaucoma Physician, Dec 2017
We are well aware that the rapidly increasing population of glaucoma patients has generated a surge in the development of new treatments, both pharmaceutical and surgical. This market demand has also incited renewed interest in existing therapies, including endocyclophotocoagulation (ECP). \
Juan Carlos Izquierdo, MD
ECP (ECP-Plus) in refractory glaucoma yields versatility, favorable safety profile with positive results.
Ophthalmology Times, Aug 1, 2014
Endoscopic view provides multiple potential applications for anterior, posterior segment surgery...
Take-home message: Endoscopic cyclophoto- coagulation with vitrectomy and pars plana treatment is effective in reducing IOP in patients with ultra-refractory glaucoma, reducing the need for medications and being relatively well tolerated by patients.
Brian A. Francis, MD
Clinical Studies