Endoscopic Cyclophotocoagulation: An Overview and Asian Perspective

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Abstract
Introduction: Surgical treatment of glaucoma has traditionally been classified as cyclodestructive (reducing inflow) or filtering (increasing outflow). Cyclodestructive procedures have traditionally been reserved for eyes with poor visual prognoses and refractory glaucomas including post-trauma, aphakia, congenital and developmental glaucoma. Since Uram described the first use of endoscopic cyclophotocoagulation (ECP) in 1992, short- and long-term outcomes for ECP have been promising. Methods: PubMed search and review of published English literature on ECP and comparison with limited results in a single Singapore ophthalmic tertiary hospital. Results: Safety and efficacy of ECP and combined phacoemulsification-ECP procedures in treatment of paediatric and adult glaucomas of various aetiologies and severities is reported. Local, short-term unpublished results from a single Singapore tertiary ophthalmic service are reported and concur with previously published results. Conclusions: Published reports and current experience with ECP have demonstrated that ECP with direct visualisation of the target tissues avoids the complications associated with “blind” trans-scleral cyclophotocoagulation by applying optimum energy to target tissue ciliary epithelium with endoscopic visualisation and infrared laser wavelength application. Significant financial barriers exist to introducing this service. It is safe and effective in controlling intraocular pressure and reducing reliance on anti-glaucoma medications. Wide-spread acceptance and use of this technique awaits large-scale randomised controlled studies.

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