Ecp Ophthalmology

study. Endoscopic cyclophotocoagulation was preformed utilizing the Uram E2 endoscopic photocoagulation machine . The procedure was performed either by the anterior , or pars plana route. In glaucoma surgery, the endoscope can help in achieving accurate keeping a tube shunt within the narrow ciliary sulcus or through pars plana.

They had a decrease in anti-glaucoma medications from a preoperative mean of 3.0 ± 1.3, to 2.0 ± 1.3 postoperatively. BCVA was stable or improved in 94%, with 6% losing several lines of Snellen acuity. Thorough treatment of the ciliary processes-combined with measures for minimizing postoperative IOP spikes and inflammation-will lead to improved outcomes when performing endoscopic cyclophotocoagulation with cataract surgery. After cataract surgery is completed a 20G special probe is introduced into the eye through exactly the same cataract incision. This probe has both a special camera in addition to fiberoptic cables that can help deliver the laser energy.
This procedure can be combined with phacoemulsification in patients who present with cataract and medically controlled glaucoma. Among the recent advances in glaucoma surgery, ECP is now widely utilized as an easy and safe, yet effective manner of reducing IOP in the treating glaucoma.

• Because a clear corneal incision is utilized with phaco-ECP, the conjunctiva remains undisturbed superiorly in the event trabeculectomy is needed.
• Now that I have had cataract surgery, I no longer have to wear glas…
• The odds ratios and 95% confidence intervals were used for measures of association with ECP because the exposure and PAU because the outcome.
• Evidence shows that endoscopic cyclophotocoagulation could be a effective and safe adjunct to cataract surgery.
• Gonioscopy and anterior segment OCT revealed that she had appositional angle closure in three to four quadrants.

Next, the surgeon injects a viscoelastic agent into the anterior chamber beneath the iris, but over the anterior lens capsule and IOL. This enlarges the area between the iris and capsule/implant complex, causing the iris to raise in a bomb fashion.
Expect weeks before your doctor sees a lesser pressure in the attention treated. Early results show that the laser could be repeated if necessary. • to address plateau-iris syndrome, where the eye comes with an anterior rotation of the ciliary process, by performing endocycloplasty. Cyclo-ablation causes shrinkage of the ciliary process, rotating it backwards, which really helps to start the peripheral angle. Recently, endoscopic cyclophoto-coagulation has arrived at the forefront because it’s currently often done in conjunction with cataract surgery, rendering it an adjunctive procedure in the first stages of glaucoma. Because it is really a minimally invasive glaucoma surgery, one could also put it in to the category of MIGS. Evidence shows that endoscopic cyclophotocoagulation can be quite a effective and safe adjunct to cataract surgery.
Furthermore, we are alert to an observer bias in measuring IOP both pre and post-operatively. We have been also aware a longer term follow-up is advisableA randomized; controlled trial can prove more accurately the outcomes from this fairly new procedure. Expressed support for just two new CPT codes and improved reimbursement for ECP when coupled with cataract surgery. Up to 1 in 5 patients undergoing cataract extraction suffers from glaucoma, and ECP remains an important option for ophthalmic surgeons seeking to decelerate the progression of glaucoma during cataract surgery.
Subsequent obstruction of a posteriorly placed tube shunt could be identified with the endoscope as well. Finally, retinal surgeons may make use of the endoscope to assist in visualization during vitrectomy, particularly in cases with cornea or lens opacity. Retinal pathology located far anteriorly, such as proliferative vitreoretinopathy, could be better identified with the endoscope as well. Furthermore, the coaxial laser capabilities allow the surgeon to perform retinal photocoagulation to these hard to reach areas. Histology of eyes that have un-dergone TCP shows widespread tissue disruption, signs of a pro-longed decrease in blood flow and coagulative necrosis of the ciliary stroma. On the other hand, during ECP you see blanching and shrinking but no exploding tissue. Histopathology after ECP demonstrates localized contraction of the ciliary processes, signs of a temporary decrease in iris root/ciliary process perfusion, less architectural disorganization and sparing of the ciliary muscle.

• The effects of phaco-ECP appear consistent on the time of the study.
• We have been also aware a longer term follow-up is advisableA randomized; controlled trial would be able to

[newline]I work through the cataract wound (usually a clear-cornea, limbal, 2.5-mm incision); I place viscoelastic in to the sulcus, which elevates the iris and lowers the IOL, providing a primary type of sight to the ciliary process. A pars plana approach may be undertaken by vitreoretinal surgeons carrying out a pars plana vitrectomy. Many other surgical options are just open to patients with OAG, but ECP can be used in a wide spectral range of glaucoma patients – either OAG or chronic angle-closure – in addition to at any disease stage. For patients with refractory glaucoma who have failed other procedures, the ECP Plus procedure has been proven to be effective .
ECP is a procedure in which a laser is used to alter section of the ciliary body, which lies behind part of the iris . IOP lowering from ECP is normally seen within the first postoperative month. However, there’s one case report of IOP lowering that was not seen until 14 weeks after ECP was performed. Getting used to endoscopy – One challenge for most surgeons may be the new viewing connection with an endoscopic approach. You’ll get the hang of it pretty quickly, understanding how to separate what the hands are doing while considering the display screen. The circulating nurse can help by maintaining the horizon on the screen.
Histologic studies confirm that there’s less tissue disruption with ECP than with transcleral cyclophotocoagulation . Lin and colleagues showed that TSCPC caused severe disruption of the ciliary process and the iris root and caused an occlusive vasculopathy out to at least one 1 month. By contrast, ECP caused localized shrinkage of the ciliary process only. ECP also caused occlusive vasculopathy but there is partial reperfusion by 1 month. They speculated that the partial return of blood flow may partially account for the lack of hypotony and phthisis with ECP instead of TSCPC.