Efficacy (not just safety)
ECP is largely successful in reducing ciliary body aqueous production. However, now that ophthalmologists are aiming for ever-lower target pressures after surgery, the extent of treatment efficacy may be the main issue. The effect of an ECP procedure is based on controlled tissue damage.
However, as it is a gentle, titratable and repeatable procedure, safety is not as overly concerning now as it had been in the past with previous more aggressive modalities of cyclo-ablation (for ECP, I prefer the term ‘cyclo-modulation’ rather than cyclo-destruction). The bigger question is whether the treatments lower pressure enough after surgery.
Think of it as an ‘untrabitional’ surgical procedure for patients with glaucoma. It is a mild process allowing for re-treatment if necessary, and patients are subject to reduced probability of sight-threatening risks associated with invasive procedures, such as trab or GDD surgery.
Cataract, glaucoma perfect pair for ECP
As an adjunct to small-incision cataract surgery, ECP is an ideal way to address moderately controlled glaucoma and cataracts in one procedure. Although cataract surgery alone may temporarily reduce IOP, targeting and ablating ciliary processes frequently enables patients to experience long-term IOP reduction comparable to the more invasive GDD procedures, but without the added risk of sight-threatening complications.
The process adds about 10 minutes to the overall surgery time and can prevent patients from needing additional glaucoma surgery. In cases where IOP is not lowered enough, I will supplement with a second ECP treatment. If IOP still remains high, I will often proceed to a trab or GDD.
Finally, if that does not produce results, I will try ECP again (perhaps via a posterior approach). In my experience, ECP helps outflow operations to work better when performed either before or after glaucoma outflow surgery.
For patients who are no longer responsive to or have an aversion to pharmacological treatments, ECP typically lowers IOP sufficiently to make it possible for them to discontinue one or two glaucoma medications and still maintain control.