By Dr Philip Bloom
IN SHORT: Employing ECP effectively reduces IOP when used early in the glaucoma treatment paradigm.
For 20 years I have effectively employed endoscopic cyclophotocoagulation (ECP) as a primary or secondary line of glaucoma treatment. ECP is a minimally invasive glaucoma surgical (MIGS) option capable of reducing IOP in the majority of patients and can potentially eliminate the need for drainage surgery, including trabeculectomy (trab) and glaucoma drainage devices (GDDs).
With few sight-threatening complications, this is an attractive option to patients facing higher-risk, invasive procedures, or it can serve as a supplemental tool that complements and enhances the effects of other procedures.
ECP combines light and endoscopy to produce a precise, visualised laser application. The endoscope allows for viewing the ciliary body from the anterior or posterior segment in real time. Ciliary processes are easily identified and treated with laser ablation, thus minimising trauma to adjacent healthy ciliary and other tissues.
Quick, sutureless and ocular surface-friendly, ECP shows destruction of the non-pigmented epithelium with little effect outside of the ciliary processes. Scanning electron microscopy displays shrinkage and effacement of the process without gross architectural destruction or collateral damage.
In contrast, eyes treated with traditional cyclophotocoagulation (CPC) demonstrate destruction of the pigmented and non-pigmented epithelium, pigment clumping, coagulative necrosis, and destruction of the deeper ciliary stroma.
The decision to proceed with ECP can be based on consideration of what some have referred to as ‘Bloom’s VUE Triad’ of factors: Visibility, oUtflow, and Efficacy. These considerations are examined in more detail as follows.