Endoscopic Photocoagulation - Meridian

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“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 <strong>Endoscopic</strong> 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
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Endoscopic Photocoagulation - Meridian

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