Uram ECP Course
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Transcript of 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
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
4 Skills for ECP
Watching Video Monitor
Accessing ciliary procesesses given approach and lens status
Inflating ciliary sulcus
Controlling long duration, invisible wavelength laser
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
AnesthesiaAnesthesia
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
IncisionIncision
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
LENS BEHIND IRIS:LENS BEHIND IRIS: VISCOELASTICVISCOELASTIC
SINGLE CHAMBER EYE:SINGLE CHAMBER EYE: INFUSIONINFUSION
AVOID HYPOTONYAVOID HYPOTONY
ECP Treatment PrincipleECP Treatment Principle
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
Inflating the Ciliary Inflating the Ciliary SulcusSulcus
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
Limbal, Over Bag / PC-IOLLimbal, Over Bag / PC-IOL
Combined Procedures:
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
No PPL for Phakic EyesNo PPL for Phakic Eyes
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
Curved Probe, LimbalCurved Probe, Limbal
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
Desired Tissue EffectDesired Tissue Effect
Whiten ciliaryWhiten ciliary processes processes
Shrink ciliaryShrink ciliary processes processes
Treat entireTreat entire ciliary process ciliary process
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
Inflating the Ciliary Inflating the Ciliary SulcusSulcus
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
Complete TreatmentComplete Treatment
INADEQUATE TREATMENT INADEQUATE TREATMENT RESULTS INRESULTS IN::
POOR IOP CONTROLPOOR IOP CONTROL ONLY TEMPORARY “GOOD” RESULTONLY TEMPORARY “GOOD” RESULT
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
Treatment ZoneTreatment Zone
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
ECP: Post-Op ECP: Post-Op MedsMeds
SAME AS PHACO ALONE SAME AS PHACO ALONE
IOP SPIKE PROPHYLAXISIOP SPIKE PROPHYLAXIS
PARACENTESISPARACENTESIS
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
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..
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
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
(#)(#)
PP
Phaco-Phaco-
ECPECP19.0819.08
±±4.144.14
15.7315.73
±±3.003.00
4.484.48
XX
10 10 -72-72
1.531.53
±±0.890.89
0.650.65
±±0.950.95
1.231.23
XX
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
ENDOSCOPIC CYCLOPHOTOCOAGULATION ENDOSCOPIC CYCLOPHOTOCOAGULATION Martin Uram, M.D., M.P.H.Martin Uram, M.D., M.P.H.
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
27%
5%68%
12%
77%
11%
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
9%
12%
79% 60%
38%
2%IOP
Phaco-ECP vs Phaco Alone:Phaco-ECP vs Phaco Alone:
Mean IOP Over TimeMean IOP Over Time
14
15
16
17
18
19
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!