Download ECP Glaucoma Surgery

ECP - Endoscopic Cyclophotocoagulation
This web page is designed to provide prospective patients with an
overview of the features and benefits of ECP, or Endoscopic
Cyclophotocoagulation, a proven, state-of-the-art minimally invasive
surgical procedure, in the management of Glaucoma.
Your surgeon will evaluate your candidacy for ECP, and will discuss the
potential risks and benefits associated with it, as well as alternative
treatments with you.
As you browse through this page, please note any questions or concerns
that you may wish to address to your patient counselor or surgeon.
To get started simply click on one of the two treatment options below:
ECP – Endoscopic Cyclo Photocoagulation
A Minimally Invasive 21st Century treatment for the Management of
Glaucoma
Combined Cataract and ECP Glaucoma Surgery
A Safe, Effective and Convenient Opportunity to Improve Your Vision While
Reducing or Completely Eliminating Your Dependence on Glaucoma
Medications.
ECP - Endoscopic Cyclophotocoagulation
Endoscopic Cyclophotocoagulation (ECP) is surgical procedure that effectively
inhibits the production of aqueous fluid in the eye, by directing laser energy under
endoscopic view to treat the surface cells of the ciliary processes typically
resulting in a decrease in intraocular pressure, and a reduction or elimination of a
patient’s dependence on glaucoma medications.
ECP has been performed globally for over 12 years, and over 30,000 patients
have been treated to date.
This minimally invasive surgical procedure has PROVEN TO be a highly safe
and effective treatment in the management of Intraocular Pressure (IOP) in
patients with Glaucoma.
Endoscopic: Intraocular visualization
Cyclo: Circular-pattern application
Photocoagulation: Tissue ablation using light energy
The Technique
The surgical technique, Endoscopic Cyclophotocoagulation (ECP) was
developed by Martin Uram, MD, MPH during the early 1990’s and has been
practiced and refined globally over the past decade.
ECP is a minimally invasive microsurgical technique that involves the use of a
Laser MicroEndoscope THAT ALLOWS viewing and DIRECT treatment of
surface layer of the ciliary processes.
These organs, or Ciliary Processes, are viewed by the surgeon on an external
monitor during the surgery. As you can see here, they vary in appearance from
eye to eye. Looking like finger-like folds, they lie in a circular array along the
underside of the iris.
THE CILIARY PROCESSES ARE a circular array of OCULAR STRUCTURES
THAT are located near the base of the underside of the iris which exude
aqueous fluid into the anterior portion of the eye.
Ciliary Processes exude the aqueous that fills the eye's anterior chamber. (The
Infrared Laser operates at a wavelength (810 nm) that is selectively absorbed by
the pigmented surface cells (ciliary epithelium) of the processes.)???? As laser
energy is directed at the process, its ability to exude aqueous fluid is inhibited.
ECP inhibits the production of aqueous by “burning” the ciliary processes with
direct laser application. The endoprobe’s infrared laser operates (at a wavelength
(810 nm) that is selectively absorbed by the pigmented surface cells (ciliary
epithelium) of the processes.)????
By balancing the amount of fluid produced with the amount drained, the surgeon
can successfully lower IOP without other major complications.
Since Dr. Uram pioneered ECP in the early 90’s, it has been practiced and
refined globally for more than a decade. The results have proven it to be one of
the most successful treatments for glaucoma in the world today.
ECP - Endoscopic Cyclophotocoagulation – Patient Benefits
Highly successful in reducing intraocular pressure in patients with Primary Open
Angle Glaucoma.
Minimally invasive endoscopically directed laser therapy affords quicker recovery
and lower complication rates than previous surgical techniques.
Over two thirds of POAG patients treated with ECP will significantly reduce the
number and/or frequency of glaucoma medications. About half are able to
discontinue them.
REDUCED MEDICATIONS – Can Improve Compliance and Control, and Lower
Prescription Costs.
REDUCED MEDICATIONS – Can Enhance Quality Of Life for many patients, for
example those that are able to discontinue use of a Beta Blocker will often feel
far more energetic.
REDUCED MEDICATIONS – Can Lower Prescription Costs.
Animation of ECP as a stand alone procedure
The Technology
Endoscope
Medical endoscopes are used to view internal parts of the body, permitting the
surgeon perspectives otherwise impossible. Generally utilizing fiberoptic imaging
and state-of-the-art, high-resolution cameras, endoscopes guide delicate
surgeries through small incisions. They allow access to areas of the body that
were previously difficult or even impossible to treat.
Medical Endoscopes are used to view internal parts of the body through small
openings. They generally utilize fiberoptic imaging, and state of the art high
resolution cameras to guide delicate surgeries through small incisions. They also
allow access to areas of the body that were previously difficult or even impossible
to treat. For example, an Orthopedic Surgeon would use an endoscope to
examine and repair a knee ligament through a ¼” wound, instead of having to
make much larger incisions to expose the treatment area.
In nearly every field of contemporary medicine, endoscopes have revolutionized
Minimally Invasive Surgery, significantly improving clinical outcomes while
reducing surgical complications and patient recovery time.
Endoscopes are used in medical fields ranging from Cardiology,
Ear/Nose/Throat, and Urology to Orthopedics, Thoracic surgery, and now,
Ophthalmology. Among the many applications are:
Arthoscopy: The examination of joints, (i.e. knee, shoulder), for diagnosis and
treatment (arthroscopic surgery).
Bronchoscopy: examination of the trachea and lung's bronchial trees to reveal
abscesses, bronchitis, carcinoma, tumors, tuberculosis, infection, inflammation.
Laparoscopy: visualization of the stomach, liver and other abdominal organs
including the female reproductive organs, for example, the fallopian tubes.
Angioscopy: visualization of the major arteries leading to the heart,
(remove all this red ? – may be too much information)
In 1991, Dr. Martin Uram designed and developed the Laser Microendoscope ,
incorporating micro optical technology utilized by the U.S. Air Force. With the
goal of treating the ciliary processes, which were previously impossible to view in
a live eye, Dr. Uram conceived of the idea of enabling simultaneous viewing and
treatment through a microendooscope featuring a unique integrated fiberoptic
bundle that allows both imaging and laser delivery through a single instrument.
The Laser MicroEndoscope has undergone continuous improvement and
refinement as fiberoptic imaging technology has evolved during the past 15
years. The Laser Microendoscope is among the smallest endoscopes used in
medicine.
Combined Cataract and ECP Glaucoma Surgery
A safe, effective and convenient opportunity to improve your vision while
reducing or completely eliminating your dependence on Glaucoma
medications.
Phacoemulsification
A procedure for removal of the crystalline lens in cataract
surgery in which an anterior capsulectomy is performed by
means of a needle inserted through a small incision at the
temporal limbus, allowing the lens contents to fall through
the dilated pupil into the anterior chamber where they are
broken up by the use of ultrasound and aspirated out of the
eye through the incision. The small incision allows the
surgeon to use very few or even no stitches to close the tiny
wound. There is usually no need for hospitalization and
patients may resume most activities within days. (Cline, et
al., Dictionary of Visual Science, 4th ed & In Focus
1993;1(1):1)
While there are other simultaneous surgical options to treat cataract patients with
elevated intraocular pressure, ECP offers the best safety record, most
predictably improved outcomes, least complicated follow up, and quickest
recovery of any.
ECP is a minimally invasive procedure that can be performed though the micro
incisions already made during Cataract Surgery, and takes only a few extra
minutes of surgical time.
Recovery, follow up visits, and complication rates are typically the same as for
Cataract Surgery alone.
Combined Cataract & ECP Glaucoma Surgery – Patient Benefits
Highly successful in reducing intraocular pressure in patients with Primary Open
Angle Glaucoma.
Minimally invasive endoscopically directed laser therapy affords quicker recovery
and lower complication rates than previous surgical techniques.
Over two thirds of POAG patients treated with ECP will significantly reduce the
number and/or frequency of glaucoma medications. About half are able to
discontinue them.
REDUCED MEDICATIONS – Can Improve Compliance and Control, and Lower
Prescription Costs.
REDUCED MEDICATIONS – Can Enhance Quality Of Life for many patients, for
example those that are able to discontinue use of a Beta Blocker will often feel
far more energetic.
REDUCED MEDICATIONS – Can Lower Prescription Costs.
Animation of ECP at the time of Cataract Surgery
ECP Clinical Outcomes Overview
Over the past ten years Clinical Studies on ECP around the globe have
confirmed that:

Over 90% of ECP Patients experience a clinically significant
reduction in IOP.

50% - 55% of ECP patients are able to discontinue Glaucoma
Medications post operatively.

75% - 80% of ECP Patients are able to reduce number and/or
frequency of Glaucoma Medications.
In the most recently published large scale study, (Ophthalmology Times, January
2006), Stanley J. Berke, MD, Clinical Professor of Ophthalmology and Visual
Sciences at Albert Einstein School of Medicine, and colleagues at Ophthalmic
Consultants of Long Island reported on over 800 Combined Cataract and ECP
cases on patients whose Intraocular Pressure was controlled by 2 or more
medications, that were followed for up to 5 years, (range 6 months to 5 years and
six months, average 2.5 years).
Clinical outcomes of these patients were compared to a control group of 180
cases on patients who were age-matched and similar to the combined
Cataract/ECP group with respect to average IOP and medication use, and
underwent cataract surgery alone.
Confirming earlier global clinical studies over 90% of patients undergoing
combined Cataract/ECP surgery were categorized as having treatment success,
(reduction of baseline IOP and reduction in the number of glaucoma Medications
used), versus about 25% in the control group.
The study also reported an average 60% reduction in the average number of
glaucoma medications being used, by patients who had undergone combined
Cataract/ECP surgery..
The outstanding safety profile of combined Cataract/ECP surgery corroborated
results from the ECP Collaborative Study Group, an ongoing international
multicenter study of more than 6,000 ECP cases. No serious complications
occurred in any patients in Dr. Berke’s study, and rates of CME (cystoid macular
edema) and other minor transient complications were similarly low (under 1
percent) in both combined Cataract/ECP patients and patients who underwent
cataract surgery alone.
CLINICAL OUTCOMES and SAFETY
(Selected Clinical Studies)
GLOSSARY
Aqueous Fluid
Ciliary Processes
Clinical Studies
Complication Rates
Cyclo
Endoscopic
Endoscopic Cyclophotocoagulation
Endoscopy
Glaucoma
Infrared Laser
Intraocular Pressure
Iris
Laser
Laser Microendoscope
Minimally Invasive Surgery
Photocoagulation
Primary Open Angle Glaucoma (POAG)
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