What to expect
The desired endpoint of treatment is whitening and shrinkage of the entire ciliary process. However, inflammation is an inevitable consequence of any intraocular procedure, including endoscopic treatment. When managed properly, inflammation is self-limiting and does not pose a problem.
To manage inflammation, I pre-treat patients with topical steroids and inject intracameral steroids at the end of the procedure. Inflammation should not be a deterrent to performing ECP. One should expect inflammation and treat it prophylactically to avoid surprises or complications.
ECP is a low-risk, minimally invasive surgical method offering IOP control and some liberation from the plethora of medications required for glaucoma patients. Using ECP earlier in the treatment paradigm to stem inflow when the outflow mechanisms are still functioning enables the greatest margin of success.
Used as a primary treatment for glaucoma in conjunction with cataract surgery, ophthalmologists can effectively reduce IOP without adding risk to the extraordinarily safe cataract surgery procedure. Consider the ‘untrabitional’ approach. Patients (and their eyes) will be happy.
Dr Philip Bloom, MD
Dr Philip Bloom is a consultant ophthalmologist and honorary senior lecturer at Western Eye Hospital and Hillingdon Hospital, London.