What is Endoscopic CycloPhotocoagulation (ECP)?
The eye is constantly making and draining fluid – the balance between the two determines the eye pressure. ECP uses a diode laser to treat the part of the eye which makes fluid (the ciliary body) in order to reduce its fluid production and thereby reduce eye pressure. It is therefore a treatment for glaucoma.
Is it a new procedure?
ECP was first developed in the early 1990s by an American ophthalmologist named Martin Uram. Since that time the equipment and procedure have been extensively studied and refined.
How is the procedure done?
A tiny endoscope (camera) is inserted into the eye to get a good view of the ciliary body (which would otherwise be hidden to the surgeon behind the iris). The laser probe then applies controlled laser energy to the ciliary body. The surgeon can see on an external monitor exactly which parts are being treated. Here is a video demonstrating the laser application schematically, together with an inset clip from a real ECP case showing the live treatment of ciliary processes:
Is ECP widely available?
The majority of eye departments in the UK do not have the expensive technology required to perform ECP. We are extremely fortunate to have secured this equipment for the benefit of our patients in Jersey. It was installed in the Jersey General Hospital in the summer of 2017.
When can ECP be done?
The best time to do ECP is to combine it with cataract surgery.
I have previously had cataract surgery. Can I now have ECP?
Theoretically yes, but the ability to perform a good treatment depends on how much scar tissue has formed around your ciliary body after cataract surgery. The rationale for selecting ECP in this situation needs to be discussed with your surgeon.
How effective is ECP at reducing eye pressure?
ECP has been shown in several studies to be effective at reducing eye pressure, and/or at reducing the number of pressure-reducing eye drops that glaucoma patients need. In a clinical study from the UK, ECP combined with cataract surgery reduced eye pressure by around 30%. ECP with higher power settings produces a more substantial pressure reduction, but carries a higher risk of the pressure going too low and of macular swelling causing visual impairment. Therefore, lower power settings are now preferred, as they can still produce significant reductions in eye pressure while minimising the rate of these complications.
What are the complications of ECP?
ECP is normally combined with cataract surgery, which itself carries rare risks of visual loss and/or the need for further procedures, in the event of complications. Adding ECP to the cataract procedure slightly increases the risk of two complications (inflammation and macular swelling, either of which can impair vision) and carries an additional risk of the pressure permanently going too low (hypotony) which is not a risk of cataract surgery alone. Finally, ECP laser can very rarely be associated with pupil shape or size abnormalities (for example, dilated pupil, or irregular pupil shape). Serious complications are still rare however, with the UK trial mentioned above documenting no major complications in their entire series.