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ENDOSCOPY QUARTERLY
JULY— SEPTEMBER 2005
VOL. 1
This is our first quarterly newsletter. This and future editions are intended to help keep our
customers updated on a variety of ECP and ophthalmic endoscopy topics including company
news, training courses, new product offerings and coding updates. We will also feature new
studies and articles and keep you informed on equipment and endoscope maintenance. We
World Leader
in Microendoscopy
hope you find this first installment helpful and welcome your suggestions for future editions.
COMPANY NEWS
You are probably aware that Endo Optiks is no longer affiliated with Medtronic Ophthalmics.
Table of Contents
Their two and a half years as our sales and marketing team were quite successful and we
♦ Company News
appreciate their contributions. Medtronic helped us increase our installed base from less than
♦ Coding and
100 units to well over 250 in the US. Many well known surgeons have become enthusiastic and
vocal supporters of the technology and several new studies have been published or will be
imminently.
Reimbursement
♦ Studies
♦ ECP Training
Endo Optiks’ new sales team is made up of the three ECP Sales Specialists who headed the
Medtronic effort. Jim Colwell (East), Stu Jones (Central), and Pete Sonntag (West) have a
♦ Surgical Pearls
combined 14 years of sales and customer support experience with Endo Optiks products and
over 30 years in ophthalmology. They understand how and why the product works and are very
proficient at helping surgeons discover the value of the instrument and learn the skills and
techniques necessary to be successful.
ECP CODING AND REIMBURSEMENT
The new CPT code 66711 was established specifically for ECP on 1/1/05.
This is now the only code that should be used for ECP. (The 65875 code
should no longer be routinely used for “stand alone” ECP cases). ECP is a
Level 2 code and the national average reimbursement amounts are $508 for physicians, $446 for ASCs and $837 for
hospitals. (These amounts are halved when ECP is performed at the time of cataract surgery.)
The ASC fee has been delayed in payment through the first half of ’05 because of an administrative oversight at CMS
when the code was enacted. An announcement was made recently establishing the reimbursement rate and stating that
claims for all ECPs performed since the beginning of the year will be honored upon resubmission on or after July 5th.
This new code is a direct indication of the growing acceptance of ECP and the increasing number of procedures
performed.
STUDIES
STUDIES
We want to help keep you current on the latest ECP findings and will soon have a section on our website with a
complete study listing and highlights of new findings and comments.
Below is the abstract for a study that was published in the Journal of Glaucoma in June, 2004. The full article can be
viewed by going to the website for the Journal of Glaucoma at www.lww.com.
A Prospective, Comparative Study between Endoscopic Cyclophotocoagulation and the Ahmed
Drainage Implant in Refractory Glaucoma.
Lima FE, Magacho L, Carvalho DM, Susanna R Jr, AVila MP.
*Federal University of Goias, Goiania, Brazil; daggerCentro Brasileiro de Cirurgia de Olhos, Goiania, Brazil; double
daggerUniversity of Sao Paulo, Sao Paulo, Brazil; and section signUniversity of Campinas, Campinas, Brazil.
PURPOSE:: To compare endoscopic cyclophotocoagulation (ECP) and the Ahmed drainage implant in the treatment of
refractory glaucoma. METHODS:: Sixty-eight eyes of 68 patients with refractory glaucoma were prospectively assigned to
either ECP or Ahmed tube shunt implantation. All procedures were performed by a single surgeon. Eyes that were included
were pseudophakic with a history of at least one trabeculectomy with antimetabolite, an intraocular pressure (IOP) equal to or
above 35 mm Hg on maximum tolerated medical therapy, and a visual acuity better than light perception. Exclusion criteria
included eyes that had had previous glaucoma drainage device implantation or a cyclodestructive procedure. Success was
defined as an IOP more than 6 mm Hg and less than 21 mm Hg, with or without topical anti-hypertensive therapy.
RESULTS:: The mean follow-up was 19.82 +/- 8.35 months and 21.29 +/- 6.42 months, for the Ahmed and ECP groups,
respectively (P = 0.4). The preoperative IOP, 41.32 +/- 3.03 mm Hg (Ahmed) and 41.61 +/- 3.42 mm Hg (ECP) (P = 0.5), and
the mean postoperative IOP, at 24 months follow-up, 14.73 +/- 6.44 mm Hg (Ahmed) and 14.07 +/- 7.21 mm Hg (ECP) (P =
0.7), were significantly different from baseline in both groups (P < 0.001). Kaplan-Meier survival curve analysis showed a
probability of success at 24 months of 70.59% and 73.53% for the Ahmed and ECP groups, respectively (P = 0.7).
Complications included choroidal detachment (Ahmed 17.64%, ECP 2.94%), shallow anterior chamber (Ahmed 17.64%, ECP
0.0%), and hyphema (Ahmed 14.7%, ECP 17.64%). CONCLUSION:: There was no difference in the success rate between the
Ahmed Glaucoma Valve and ECP in refractory glaucoma. The eyes that underwent Ahmed tube shunt implantation had more
complications than those treated with ECP.
PMID: 15118469 [PubMed - as supplied by publisher]
MORE ON STUDIES
Several large ECP patient studies defining long term outcomes for combined cataract ECP are moving toward
publication.
We are very pleased to report that the preliminary results are excellent and consistent with earlier studies. In fact,
outcomes reported are surprisingly consistent for surgeons who do the same number of clock hours of treatment. The
most typical average results for 270 degrees of ECP treatment are a 35% drop in IOP PLUS a 35% drop in
medications. (Some earlier studies by Berke, Mackool and others show a less dramatic impact because they were
only treating 180 degrees at the time.)
If you have a study in mind or want to discuss your results please contact us. There are many important aspects of
ECP that could be investigated. One example is what impact ECP might have on diurnal fluctuations. One could
speculate that post ECP patients could have smaller fluctuations. If so, does that reduce their long term risk for
disease progression?
ECP TRAINING
Saturday, September 17th
Wynn Hotel, Las Vegas, NV
10 am — 12 pm
Sunday, October 16th
During AAO
Hilton, McCormick Place
Chicago, IL
6—9 pm
TRAINING COURSES
We will be hosting three ECP training courses this year. Two are in the box to
the left and a third will take place in Los Angeles at the Doheny Eye Institute in
November. (The exact November date will be known shortly.)
These courses are structured for the novice - someone who is already doing ECP
but wishes to become certified or expand their expertise.
A didactic and Q & A session will be followed by a wet lab. Sign up early by
emailing us at [email protected] or by calling us at 1-800-756-3636.
SURGICAL PEARLS
If your results are not as dramatic as those reported by others we believe there are two likely explanations. First, you may
not be treating enough of the ciliary processes. There is general agreement that it takes a good 270 degrees of treatment
to consistently achieve the desired response. Many surgeons who now do 300+ degrees on almost all patients see no
additional risk and a much more dramatic response in IOP. (We have still heard of no instances of ECP induced hypotony
or phthysis in a POAG patient. It seems to be very difficult to over-treat except on NVG, some pediatric cases and a few
other unusual situations.)
The second reason for less than optimal response involves the level of energy delivered to the tissue and the duration of
the burn. A fast burn resulting in instant tissue shrinking and whitening will only impact the very surface of the processes,
with the underlying tissue remaining viable. A slower burn is recommended with several seconds of energy directed at
each process. If the processes pop, turn down the power or move the endoscope further from the target. Going back over
areas you’ve already done will increase the impact of the treatment. Also, be sure to treat the valleys between the
processes. (Some surgeons suggest it is better to treat the top part of each process first because the shrinkage exposes
more of the bottom tissue and the valleys.)
We hope you found our newsletter informative.
If you have any comments or suggestions for future issues
please don’t hesitate to contact us at -800-756-3636 or via email at
[email protected]
39 Sycamore Ave.,
Little Silver, New Jersey 07739
Tel: 732 530 6762
800 756 3636
email: info@endoop tiks.co m
Fax : 732 530 5344
www.endoop tiks.co m
e ma i l : info@endoop tiks .co m
www. endoop tiks .co m