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Endoscopic cyclophotocoagulation.

Seibold LK, SooHoo JR, Kahook MY - Middle East Afr J Ophthalmol (2015 Jan-Mar)

Bottom Line: In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments.In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP.Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Colorado Eye Center, Aurora, CO 80045, USA.

ABSTRACT
In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.

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(a) Light microscopy of ciliary processes after trans-scleral cyclophotocoagulation treatment showing separation of the pigmented and nonpigmented ciliary epithelium (wavy arrow), pigment clumping (arrowheads), coagulative necrosis of the underlying ciliary stroma (asterisk), and gross destruction of the tissue architecture (straight arrows). (b) Light microscopy of ciliary processes treated with endoscopic cyclophotocoagulation showing destruction of the nonpigmented epithelium and clumping of the pigmented epithilium (arrowheads) without gross architectural destruction or collateral damage
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Figure 3: (a) Light microscopy of ciliary processes after trans-scleral cyclophotocoagulation treatment showing separation of the pigmented and nonpigmented ciliary epithelium (wavy arrow), pigment clumping (arrowheads), coagulative necrosis of the underlying ciliary stroma (asterisk), and gross destruction of the tissue architecture (straight arrows). (b) Light microscopy of ciliary processes treated with endoscopic cyclophotocoagulation showing destruction of the nonpigmented epithelium and clumping of the pigmented epithilium (arrowheads) without gross architectural destruction or collateral damage

Mentions: In human autopsy eyes, Pantcheva et al. compared the tissue effects of ECP to CPC.10 Eyes treated with CPC demonstrated destruction of the pigmented and nonpigmented epithelium, pigment clumping, coagulative necrosis and destruction of the deeper ciliary stroma [Figure 3a]. By contrast, ECP-treated eyes showed destruction of the nonpigmented epithelium with little effect outside of the ciliary processes [Figure 3b]. Scanning electron microscopy displayed shrinkage and effacement of the processes without gross architectural destruction or collateral damage.


Endoscopic cyclophotocoagulation.

Seibold LK, SooHoo JR, Kahook MY - Middle East Afr J Ophthalmol (2015 Jan-Mar)

(a) Light microscopy of ciliary processes after trans-scleral cyclophotocoagulation treatment showing separation of the pigmented and nonpigmented ciliary epithelium (wavy arrow), pigment clumping (arrowheads), coagulative necrosis of the underlying ciliary stroma (asterisk), and gross destruction of the tissue architecture (straight arrows). (b) Light microscopy of ciliary processes treated with endoscopic cyclophotocoagulation showing destruction of the nonpigmented epithelium and clumping of the pigmented epithilium (arrowheads) without gross architectural destruction or collateral damage
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4302471&req=5

Figure 3: (a) Light microscopy of ciliary processes after trans-scleral cyclophotocoagulation treatment showing separation of the pigmented and nonpigmented ciliary epithelium (wavy arrow), pigment clumping (arrowheads), coagulative necrosis of the underlying ciliary stroma (asterisk), and gross destruction of the tissue architecture (straight arrows). (b) Light microscopy of ciliary processes treated with endoscopic cyclophotocoagulation showing destruction of the nonpigmented epithelium and clumping of the pigmented epithilium (arrowheads) without gross architectural destruction or collateral damage
Mentions: In human autopsy eyes, Pantcheva et al. compared the tissue effects of ECP to CPC.10 Eyes treated with CPC demonstrated destruction of the pigmented and nonpigmented epithelium, pigment clumping, coagulative necrosis and destruction of the deeper ciliary stroma [Figure 3a]. By contrast, ECP-treated eyes showed destruction of the nonpigmented epithelium with little effect outside of the ciliary processes [Figure 3b]. Scanning electron microscopy displayed shrinkage and effacement of the processes without gross architectural destruction or collateral damage.

Bottom Line: In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments.In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP.Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Colorado Eye Center, Aurora, CO 80045, USA.

ABSTRACT
In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.

Show MeSH
Related in: MedlinePlus