Uram ECP Course

Endoscopic Endoscopic CycloPhotocoagulationCycloPhotocoagulation

Martin Uram MD, MPHMartin Uram MD, MPH

Laser EndoscopeLaser Endoscope

ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.

E2 Laser and Endoscopy System

4 Skills for ECP

Watching Video Monitor

Accessing ciliary procesesses given approach and lens status

Inflating ciliary sulcus

Controlling long duration, invisible wavelength laser

AnesthesiaAnesthesia

IncisionIncision

LENS BEHIND IRIS:LENS BEHIND IRIS: VISCOELASTICVISCOELASTIC

SINGLE CHAMBER EYE:SINGLE CHAMBER EYE: INFUSIONINFUSION

AVOID HYPOTONYAVOID HYPOTONY

ECP Treatment PrincipleECP Treatment Principle

Inflating the Ciliary Inflating the Ciliary SulcusSulcus

Limbal, Over Bag / PC-IOLLimbal, Over Bag / PC-IOL

Combined Procedures:

No PPL for Phakic EyesNo PPL for Phakic Eyes

Curved Probe, LimbalCurved Probe, Limbal

Desired Tissue EffectDesired Tissue Effect

Whiten ciliaryWhiten ciliary processes processes

Shrink ciliaryShrink ciliary processes processes

Treat entireTreat entire ciliary process ciliary process

Inflating the Ciliary Inflating the Ciliary SulcusSulcus

Complete TreatmentComplete Treatment

INADEQUATE TREATMENT INADEQUATE TREATMENT RESULTS INRESULTS IN::

POOR IOP CONTROLPOOR IOP CONTROL ONLY TEMPORARY “GOOD” RESULTONLY TEMPORARY “GOOD” RESULT

Treatment ZoneTreatment Zone

ECP: Post-Op ECP: Post-Op MedsMeds

SAME AS PHACO ALONE SAME AS PHACO ALONE

IOP SPIKE PROPHYLAXISIOP SPIKE PROPHYLAXIS

PARACENTESISPARACENTESIS

ECP COLLABORATIVE STUDY GROUPECP COLLABORATIVE STUDY GROUP

COMPLICATIONSCOMPLICATIONS

IOP Spike IOP Spike 14.5%14.5%HemorrhageHemorrhage 3.8% 3.8%Serous Choroidal Effusion Serous Choroidal Effusion 0.36%0.36%IOL Dislocation IOL Dislocation 0.36%0.36%CME CME 1.03%1.03%RD RD 0.27%0.27%Massive Choroidal Hemorrhage Massive Choroidal Hemorrhage 0.09%0.09%Hypotony or Phthisis Hypotony or Phthisis 0.12%0.12%NLP Vision NLP Vision 0.12%0.12%Cataract Cataract 24.5%24.5%Acute Graft Rejection Acute Graft Rejection 5.3%5.3%Chronic Graft RejectionChronic Graft Rejection 00Chronic Inflammation Chronic Inflammation 00Flat ACFlat AC 00Endophthalmitis Endophthalmitis 00Diplopia Diplopia 00Wound Leak Wound Leak 00Bleb ComplicationsBleb Complications 00

5824 PATIENTS

707 Patients

626 Randomized to Phaco-ECP Group

81 Randomized to Phaco Alone

5 Surgeons

Parameters such as VA, IOP, Meds, & complications were followed

Mean follow-up was 3.2 years (0.5 to 5.8 years)

Phaco-ECP vs Phaco AlonePhaco-ECP vs Phaco AloneStanley J. Berke, M.D., FACS, et. al..

Phaco-ECP vs Phaco AlonePhaco-ECP vs Phaco Alone

Pre-opPre-op

IOPIOP

mmHgmmHg

Post-opPost-op

IOPIOP

mmHgmmHg

PP Pre-opPre-op

MedsMeds

(#)(#)

Post-opPost-op

MedsMeds

(#)(#)

Phaco-Phaco-

ECPECP19.0819.08

±±4.144.14

15.7315.73

±±3.003.00

4.484.48

10 10 -72-72

1.531.53

±±0.890.89

0.650.65

±±0.950.95

1.231.23

10 10 -85-85

Phaco Phaco

AloneAlone18.1618.16

±±3.383.38

18.9318.93

±±4.124.12

.01.011.201.20

±±0.830.83

1.201.20

±±0.870.87

0.500.50

Phaco-ECP vs Phaco Alone: Phaco-ECP vs Phaco Alone:

Medications at End of Follow-UpMedications at End of Follow-Up

no change increase decrease

Phaco-ECP Phaco Alone

Phaco-ECP vs Phaco Alone:Phaco-ECP vs Phaco Alone: Post-Op IOP ChangePost-Op IOP Change

no change increase decrease

Phaco-ECP Phaco Alone

79% 60%

Phaco-ECP vs Phaco Alone:Phaco-ECP vs Phaco Alone:

Mean IOP Over TimeMean IOP Over Time

20Phaco-ECPPhaco Alone

Phaco-ECP 19.08 16.03 16.14 16.09 16.03

Phaco Alone 18.16 17.62 16.28 16.87 18.93

Pre-Op 6 Months 1 Year 2 Years 3 Years

mmHg 1.53 Meds

1.20 Meds

0.65 Meds

1.20 Meds

ComplicationsComplications

No serious complications No serious complications

were reported in either groupwere reported in either group

1 patient in each group 1 patient in each group

developed CMEdeveloped CME

Phaco-ECP vs Phaco Alone

Phaco-ECP vs Phaco AlonePhaco-ECP vs Phaco AloneGlaucoma Medication Cost AnalysisGlaucoma Medication Cost Analysis

Pre-OpPre-Op Post-OpPost-Op Savings/LossSavings/Loss

Phaco-ECP monthly patient costPhaco-ECP monthly patient cost $220.08$220.08 $94.78$94.78 $125.30$125.30

Phaco-ECP annual patient costPhaco-ECP annual patient cost $2,640.92$2,640.92 $1,137.35$1,137.35 $1,503.57$1,503.57

Phaco Alone monthly patient costPhaco Alone monthly patient cost $144.45$144.45 $160.28$160.28 ($15.83)($15.83)

Phaco Alone annual patient costPhaco Alone annual patient cost $1,733.40$1,733.40 $1,923.36$1,923.36 ($189.96)($189.96)

Estimated US annual savingsEstimated US annual savings** $846,765,000 $846,765,000

* 2.5 million cataract procedures annually. 20% of cataract surgery patients concurrently treated with glaucoma medications.

Phaco-ECP: ConclusionPhaco-ECP: Conclusion

Hard to get in troubleHard to get in trouble

It usually worksIt usually works

It’s fun!It’s fun!

Uram ECP Course

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Transcript of Uram ECP Course

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