Endoscopic cyclophotocoagulation (ECP) is a specialized surgical procedure designed to manage certain eye conditions by reducing pressure inside the eye. It offers a targeted way to address elevated intraocular pressure, which can contribute to various eye health concerns.
Understanding Endoscopic Cyclophotocoagulation
ECP involves using a laser to treat the ciliary body, located behind the iris. The ciliary body continuously produces aqueous humor, a clear fluid that fills the front of the eye. When this fluid does not drain properly, or too much is produced, it can lead to increased pressure within the eye, known as intraocular pressure (IOP).
The “endoscopic” aspect of ECP makes it unique. A tiny camera, integrated into a laser probe, allows the surgeon to directly visualize the ciliary body during the procedure. This direct visualization enables precise application of laser energy to the ciliary processes, structures within the ciliary body. Treating these processes reduces the production of aqueous humor, thereby lowering the eye’s internal pressure.
Conditions Treated by Endoscopic Cyclophotocoagulation
ECP is a treatment option for various forms of glaucoma, eye diseases characterized by optic nerve damage often linked to elevated intraocular pressure. This includes common types such as open-angle glaucoma and narrow-angle glaucoma, as well as more complex cases like refractory glaucoma. ECP is particularly useful when medications or other surgical interventions have not adequately controlled eye pressure, or when other treatments are not suitable for a patient.
The procedure aims to lower intraocular pressure to help prevent further damage to the optic nerve and preserve vision. It achieves this by directly reducing fluid production within the eye, which is a different mechanism than many other glaucoma surgeries that focus on improving fluid drainage. ECP can be performed as a standalone procedure or in combination with cataract surgery for patients who have both conditions.
The Endoscopic Cyclophotocoagulation Procedure
The ECP procedure typically takes place in an outpatient operating room setting and usually lasts about 15 minutes. Patients commonly receive “twilight” anesthesia for comfort, along with a local numbing medication for the eye. A small incision, usually 1.5-2.2 mm in length, is made in the cornea or through a limbal incision.
Through this small incision, a thin laser probe is carefully inserted into the front part of the eye. This probe contains fiber optics that allow the surgeon to see the ciliary body directly on a video monitor. The surgeon then delivers targeted laser energy to the ciliary processes to reduce fluid production. Typically 270 to 360 degrees of the ciliary processes are treated to achieve pressure reduction.
Life After Endoscopic Cyclophotocoagulation
Following the ECP procedure, patients are discharged with a clear plastic shield or patch over the operated eye, and an adult will need to drive them home due to sedation. Mild soreness in the eye is common, and vision may initially be worse before gradually improving over one to two weeks. Eye drops, typically a steroid and an antibiotic, are prescribed to manage inflammation and prevent infection, with the regimen adjusted by the doctor during follow-up visits.
Patients are advised to wear the plastic shield while sleeping for one or more weeks to protect the eye and sunglasses during the day when outdoors. For the first one to two weeks, it is recommended to avoid strenuous activities, heavy lifting, bending, rubbing the eye, wearing eye makeup, and swimming. Follow-up appointments are scheduled, usually the day after surgery, then about a week later, and again a few weeks after that, to monitor eye pressure and overall healing. The full effect of pressure reduction may take some time to become apparent, and some patients may still require glaucoma medications, though often at a reduced dosage.