Endoscopic Photocoagulation

Endoscopic Photocoagulation
Making a Difference.

ECP transcends prior
technical limitations and
offers a bright, new solution for
the treatment of glaucoma.
The compact E2 system contains a video
camera, xenon light source, and a semiconductor
diode laser tuned to 810nm
wavelength. This power console features
adjustable laser output, pulse width, light
and aiming beam intensity.
† M Uram, MD, MPH holds multiple patents for
endoscopic technologies, with financial interest in
EndoOptiks, Inc. and its products.
Empowerm
110° panoramic wide field
illumination delivers maximum
intraocular visibility with a
175Watt Xenon light source.
Endoscopic CycloPhotocoagulation (ECP) is a surgical
approach to glaucoma management that employs light
endoscopy and visualized laser application. Five
patents combine the modalities of light, image, and
laser in a single, powerful 20Ga instrument. The result
is the selective ablation of pigmented, ciliary epithelium
tissue, with minimal impact to surrounding, nontargeted
anatomy.
Remarkably, all forms of glaucoma can be effectively
treated with this technology. With continuous, direct
imaging of the ciliary processes, controlled laser
energy is delivered; IOP is lowered and aqueous production
is controlled, with superior long-term results.
Light Image Laser
10K pixel resolution allows clear
imaging of ocular tissues from
the anterior or posterior segment.
Precise, 810nm, 2.0Watt diode
laser energy, in pulsed or
continuous mode, is delivered
to targeted intraocular tissues.

ent
The comprehensive armamentarium of endoscopes,
span the need from simple illumination, to laserimaging
fibers - for anterior ECP applications as well as
posterior PRP delivery. DCR probes are also provided
with the higher intensity 12Watt power console.
Optional consoles allow modular flexibility of light,
image, and/or laser power selection.
This powerful new technology has
been embraced by ophthalmologists
across specialties.
System Simplicity
Light
Image
Laser
Sequential organization of system settings and parameters, and backlighted
LCD front panel, makes set up and operation rapid and intuitive.
Light
Cataract
Glaucoma
Pediatric
Laser
Retina
Image
“ECPs greatest worth is its ability to
reduce or eliminate glaucoma
medications and thereby
improve compliance”
Richard J. Mackool, MD
Cataract Surgeon
“...you can use the endoscope to
visualize the angle directly
and treat it.”
Stanley J. Berke, MD, FACS
Glaucoma Specialist
“The advantage of being able
to see each individual ciliary
process, as they are treated,
is tremendous.”
David A. Plager, MD
Pediatric Ophthalmologist
“ECP employs a triple
function micro endoscope to
provide heretofore impossible
intraocular visualization”
Martin Uram, MD, MPH †
Retina Specialist

“In our patients with controlled
glaucoma and cataracts,
combined ECP with
phaco IOL insertion
is my treatment
RJ Mackool, MD of choice.”
This 2-5 minute, reimbursed
technique is ideal for patients
with medically controlled glaucoma.
Intended surgical results lower
intraocular pressure (IOP) longterm,
reduce required patient
medications (minimizing
compliance issues), and
retard progression of the
glaucomatous condition.
“Our goal is to provide the best patient
care in our practice. If I can perform
advanced phaco and reduce my patients’
dependency on glaucoma medications,
I have succeeded to this end.”
Stephen B Wiles, MD
Cataract Surgeon
In a combined phacoemulsification/ECP procedure, an
existing clear corneal or limbal incision is sufficient to
accommodate the 20Ga endoprobe. In a stand-alone ECP
case, the ciliary processes may be approached from a
limbal or a pars plana incision. From this single entry,
anatomy is accurately identified, and between 180° to 200°
of ciliary processes can effectively be reached; a secondary
incision will accommodate a full 270° to 360° treatment.
Versatility &
"All of our procedures are done
through the clear cornea. In the
phakic patient, a sodium hyaluronate
viscoelastic is injected between the iris
and anterior lens surface to broaden
access to the ciliary processes."
DA Plager, MD
Pediatric Ophthalmologist
"I treat some eyes through the pars
plana, with deranged anterior segment
anatomy, where there might
be a lot of synechiae between the iris
and the lens capsule.
RJ Mackool, MD
Direct, continuously monitored visualization,
with aiming beam precision, produces repeatable, titratable
shrinkage of targeted tissues. Most impressive,
beyond the incremental benefits of the ECP procedure,
endoscopy allows the accurate assessment of: zonular
dehiscence, capsular bag integrity, residual cortical
material, intended haptic placement, and anterior
hemorrhage. Clearly, this capability should only enhance
clinical outcomes.
Clear Corneal Entry
Pars Plana Approach
Target Approach
“Anybody who can do phaco can learn ECP in a heartbeat.
You can learn to use the probe to ‘paint’ the ciliary processes
in a continuous motion. Combined with phaco,
ECP takes an extra 2 to 5 minutes.”
RJ Mackool, MD
Clear corneal entry, through the existing
phaco wound, allows treatment of
Phakic, Pseudophakic, or Aphakic eyes.
Laser delivery occurs either over, or
through, the capsular bag.
Pars plana approach may be employed,
combined with Vitreous surgery, for
Pseudophakic or Aphakic patients.

Control
“Unlike transscleral
cylodestructive procedures,
the surgeon can see the ciliary
processes and therefore can titrate
laser delivery properly.”
M Uram, MD, MPH
Visually titratable results are
achieved, from 180 o to 360 o , as
processes blanch and shrink to
desired composition.
Pulsed laser application
delivers selective ciliary process
treatment. Continuous laser mode
allows for rapid ablation, in a
'painting' technique.
“I also use the endoscope during
procedures in which I wish to examine
the ciliary sulcus. Such cases include
those with dislocated or decentered
IOLs, or possible retained lens
fragments and/or abnormalities
of the capsule/zonules.”
RJ Mackool, MD
Haptic in the Bag
180 o -360 o Range Haptic Piercing
Ciliary Body
Laser Treated Processes AC-IOL Piercing Iris
Proper IOL and lens
haptic placement is easily
confirmed using simple
endoscopic technique.
Angle, Iris, Lens
Residual Lens Fragments
Posterior View of Processes
Thickened Zonules in
Pseudoexfoliation
Application/Impact IOL/Haptic Position Endoscopic Discovery Retina
Ophthalmic Endoscopy
broadens diagnostic assessment
and surgical treatment
across specialties.
“I do ECP on every one of my cataract patients who is also on glaucoma
medication, because it works so well... through a single incision I can
initially treat approximately 210 o to 240 o of ciliary processes.”
MS McFarland, MD
“Combined with phaco, ECP takes
an extra two minutes. The endoscope
is also a great teaching tool...
providing a virtual tour of the eye.”
Alan B Aker, MD
Cataract Surgeon
Retina at Ora Serrata
Dropped Nucleus
Diabetic Retinal Hemorrhage
Posterior segment views provide
clear imaging of the macula and
optic nerve head, in addition to
post-operative retinal integrity at
the ora serrata.
“Another use of the endoscope is as a
visualization tool in any patient with
a cloudy cornea... to see the status of
the optic nerve and retina.”
SJ Berke, MD, FACS
Glaucoma Specialist

Successful surgical techniques
are measured by compelling
long term, clinical findings.
ECP is supported by more
than five years of data.
“I do a combined procedure on every cataract
patient on glaucoma medication... If I can
eliminate one or two drops... a beta-blocker...
(patients) just feel better. It’s a really nice thing
you can do for your patients.”
Alan B. Aker, MD
“I manage my ECP patients just as I
do a postoperative cataract. I see
them at one day and one week, and
probably 90% of them are cell free
at two weeks.”
MS McFarland, MD
When compared to all other surgical techniques for
glaucoma management, ECP meets and exceeds the
long term goal for reduced IOP and topical medications.
Even in studies that compared 'phaco alone' to 'phaco
with ECP', the combined procedure showed no higher
complication rates, while intended, long-term, positive
results were significantly elevated.
Relative to traditional transscleral “cyclodestructive”
approaches, intraocular ECP has repeatedly earned
marked distinction.
Measured
Without incidence of CME or
major complications, ECP
reduced IOP 38% further than
Phaco surgery alone. In addition,
87% of these patients benefited
from reduced medications, while
more than 60% no longer needed
any pharmaceutical management.
“You can’t do phaco expecting that
pressures will be lowered.”
SJ Berke, MD, FACS
180° ablation resulted in a 15%
decrease in IOP and 68%
reduction in medications, without
visual loss or major complications
Berke, SJ., et al.
J Glaucoma 2000; 9:1.
“The ideal patient for a combined procedure is one who is
controlled, or at least marginally controlled with glaucoma
medications... We should never underestimate how much patients
desire to get off one or more of their glaucoma medications.”
RJ Mackool, MD
ECP mean CONTROL mean
f/u = 25 mo f/u = 44 mo Ps
Mean change in IOP (mmHg) –3.3 –2.4 .48
Decreased Meds (%) 87 9 .01
Same (%) 13 73 .01
Increased Meds (%) 0 18 .001
No meds (%) 61 5 .01
CME (%) 0 0
Major complications (%) 0 0
Mackool: ECP vs. Phaco Alone �
Mean Ablation
25 eyes,
mean f/u 11 months
180°
Mean Decrease IOP 15%
Mean Reduction of Meds 68%
Post-op Visual Loss 0%
Major Complications 0
Berke: ECP Study �
Histology showing selective
ablation of the ciliary epithelium.
� Clinical studies and scientific
data are available upon request.

Without the high failure rates associated with
transscleral techniques, ECP is not reserved for
end-stage glaucoma. Treatments have proven far
superior in accurately isolating ciliary processes,
discretely ablating ciliary epithelium, and achieving
desired results - without missing, or over/under treating
the target tissue.
Further, devastating complication rates are lowest
following ECP, and postoperative patient management
is facilitated relative to traditional glaucoma procedures.
Results
“With ECP, (reduced pressure...) usually happens during the first six to eight
weeks. A seven year follow-up study shows... few patients decompensate after
the second year, as would be expected with filtration procedures.”
M Uram, MD, MPH
2 12 24 36 48 60
Follow-Up (months)
Long Term IOP Control �
OAG OAG with CACG CACG with NVG PED GL Phaco & Uncontrolled Phaco & Controlled
Failed Surgery Failed Surgery Glaucoma Surgery Glaucoma Surgery
TRAB 90% 50% 50% 30% NA < 50% 70% NA
TUBE NA 50-70% 50-70% 50-70% 50-70% < 50% NA NA
TSCPC NA NA 30-50% 30-50% 30-50% < 50% NA NA
ECP 90% 90% 90% 90% 90% > 50% 90% + 90%
Uram: IOP Control - Results per Procedure �
Minor Devastating Visual Endophthalmitis Delayed Operative Intensity of Post
Complications Complications Acuity Loss Failures Time (1-4) Op Care (1-4)
TRAB 10-50% 5-10% 5-10% 1%/yr > 50% 3 4
TUBE 30-50% 30% ~10% 1% ~10-30% 4 3
TSCPC > 50% 30% > 40% NA ~ 40% 2 2
ECP 3-8% < 1% < 1% 0% 0-5% 1 1
Uram: Complications per Procedure �
IOP (mm Hg)
50
40
30
20
10
0
“... if the patient has good visual potential, I use the
endolaser, because I think we risk decreasing their vision
with a transscleral approach.” SJ Berke, MD
NVG
APH/PS
Phakic POAG
Combined
Congenital
“There is no comparison (between ECP and cyclodestructive
techniques). I personally would not do a transscleral laser
or cyclocryo procedure.” RJ Mackool, MD
Remarkably, all forms of
glaucoma respond to ECP with
comparable, sustained results.
“In no way can ECP be
compared with true cyclodestructive
techniques. This distinction exists in
patient selection, patient tolerance,
clinical complications, and long
term results.”
SB Wiles, MD
ECP proves more efficacious in
reducing IOP, over 24 months,
than trabeculectomy, tube implants,
and transscleral treatments.
Relative to these same
procedures, ECP produced the
smallest percentage of minor
complications, visual acuity loss,
or devastating complications.

Endo
Optiks
System
Components
Laser and Endoscopy Systems Light Image Laser
OME2000 E2 Compact Microprobe Laser
and Endoscopy System • • •
OME3000 E3 Compact Microprobe High Power Laser
and Endoscopy System • • •
OME4000 E4 Endoscopy System • •
OME1500 12 Watt Diode Laser •
OME1600 LX - Mini Light Source (Metal Halide) •
Endoscopes, Probes and Fibers Light Image Laser E2 E3 E4 12W
OME200SMAE Ophth. Laser Endoscope - Semi-Disposable (1/ea) • • • • • • •
OME200SMAX Ophth. Laser Endoscope with Custom
Laser Connector - Semi-Disposable (1/ea) • • • •
OME200L Ophth. Endoscope - Light and Camera
Semi-Disposable (1/ea) • • • • •
VPH200 Endophotocoagulation Probes
Disposable, Single Use (5/bx) • • • •
VPH200A Endophotocoagulation Probe
Reusable, Autoclavable (1/ea) • • • •
VP5100 20 Gauge Illumination Probe
Disposable, Single Use (5/bx) • • • •
OME20LA Illuminated Laser Probe, Wide Field
Reusable, Autoclavable (1/ea) • • • • • •
VP200W Wide Field Illumination Probe
Reusable, Autoclavable (1/ea) • • • •
VP5330C Disposable Laser Fiber (5/bx) • • •
VP5330TR Disposable Transcleral Laser Fiber (5/bx) • • • •
Accessories E2 E3 E4 12W
OME300Z Video Adapter Upgrade • • •
MON001 Sony Video Monitor - 13" • • •
CT001 Custom Operating Room System Cart • •
OME100LF Diode Laser Safety Filter for Zeiss Microscope • • •
OME100LFM Diode Laser Safety Filter for Moller Microscope • • •
OME100LFW Diode Laser Safety Filter for Wilde Microscope • • •
LG001 Diode Laser Safety Goggles • • •
VP6200 Sterilization Tray • • • •
FC401655 Flight Case with Wheels & Telescoping Handle • • • •
405681 Flight Case with Wheels • • • •
VP5120 Endoscopic Blade • • •
Medtronic Solan
6743 Southpoint Drive North, Jacksonville, Florida 32216-0980 USA
800-535-4646 • 904-296-9600 • Fax 904-279-2630 • www.medtronicsolan.com
All products are manufactured by EndoOptiks, Inc., and exclusively distributed by Medtronic Solan.
Console Compatibilty •
Typical setup of E2 for ECP •
Available Modalities •
� Clinical studies and scientific data are available upon request.
† M Uram, MD, MPH holds multiple patents for Endoscopic Technologies, with financial interest in EndoOptiks, Inc. and its products.
980029.0702