uram powerpointpresentation

1. Endoscopic
CycloPhotocoagulation
Martin Uram MD,
MPH

2. Laser Endoscope
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

3. E2 Laser and Endoscopy System
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

4. 4 Skills for ECP
Watching Video Monitor
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Accessing ciliary procesesses given
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approach and lens status
Inflating ciliary sulcus
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Controlling long duration, invisible
⇒
wavelength laser
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

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

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

7. ECP Tr eatment
Principle
⇒
L NS B H
E E IND IRIS: VISCOE AST
L IC
⇒
SINGL CH B R E : INF
E AM E YE USION
AVOID HYPOTONY
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

8. Inflating the Ciliar y
Sulcus
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

9. Combined Procedures:
Limbal, Over Ba g / PC-IOL
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Second Outline
Level
Third Outline
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Fourth
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ENDOSCOPIC CYCLOPHOTOCOAGULATION
− Fifth
Martin Uram, M.D., M.P.H.

10. No PPL for Phakic Eyes
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

11. Curved Probe, Limbal
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Second Outline
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Level
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Level
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Second Outline
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Fourth
Level Outline
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Level
Martin Uram, M.D., M.P.H.
− Third Outline

12. Desired Tissue Ef fect
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Whiten ciliary outline text format
processes
Second Outline
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Shrink ciliary
Level
processes 
ClickThird Outline
− to edit the
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Treat entire outline text format
Level
ciliary process
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Second Outline
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Fourth
Level Outline
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Level
Martin Uram, M.D., M.P.H.
− Third Outline

13. Inflating the Ciliar y
Sulcus
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

14. Complete Treatment
INADEQUATE TREATMENT
RESULTS IN:
⇒
POOR IOP CONTROL
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ONLY TEMPORARY “GOOD” RESULT
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

15. Treatment Zone
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

16. ECP: Post-Op Meds
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SAME AS PHACO ALONE
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IOP SPIKE PROPHYLAXIS
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PARACENTESIS
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

17. ECP COLLABORATIVE STUDY
GROUP
5824 PATIENTS
COMPLICATIONS
IOP Spike 14.5%
Hemorrhage 3.8%
Serous Choroidal Effusion 0.36%
IOL Dislocation 0.36%
CME 1.03%
RD 0.27%
Massive Choroidal Hemorrhage 0.09%
Hypotony or Phthisis 0.12%
NLP Vision 0.12%
Cataract 24.5%
Acute Graft Rejection 5.3%
Chronic Graft Rejection 0
Chronic Inflammation 0
Flat AC 0
Endophthalmitis 0
Diplopia 0
Wound Leak 0
Bleb Complications 0

18. Phaco-ECP vs Phaco Alone
Stanley J. Berke, M.D., FACS, et. al..
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707 Patients
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626 Randomized to Phaco-ECP Group
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81 Randomized to Phaco Alone
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5 Surgeons
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Parameters such as VA, IOP, Meds, &
complications were
followed
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Mean follow-up was 3.2 years (0.5 to 5.8 years)
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

19. Phaco-ECP vs Phaco Alone
Pre-op Post-op P Pre-op Post-op P
IOP IOP Meds Meds
mmHg mmHg (#) (#)
Phaco- 19.08 15.73 4.48 1.53 0.65 1.23
ECP ± ± X ± ± X
4.14 3.00 10 -72 0.89 0.95 10 -85
Phaco 18.16 18.93 1.20 1.20
Alone ± ± .01 ± ± 0.50
3.38 4.12 0.83 0.87
ENDOSCOPIC CYCLOPHOTOCOAGULATION
Martin Uram, M.D., M.P.H.

20. Phaco-ECP vs Phaco Alone:
Medications at End of Follow-Up
Phaco-ECP Phaco Alone
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11%
27% 
Second Outline
12%
Level
5%
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68% edit the 
ClickThird Outline
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77%
outline text format outline text format
Level
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Fourth
no change increase decrease
Level Level Outline
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21. Phaco-ECP vs Phaco Alone:
Post-Op IOP Change
Phaco-ECP Phaco Alone
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2%
IOP
9% outline text format
12% Second Outline
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38%
Level
79%
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− to 60% the
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outline text format outline text format
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Fourth
no change increase decrease
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− Third Outline Level
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22. Phaco-ECP vs Phaco Alone:
Mean IOP Over Time
20
1.53 Meds Phaco-ECP
mmHg
Phaco Alone
19
1.20 Meds
18
1.20 Meds
17
16 0.65 Meds
15
14 Pre-Op 6 Months 1 Year 2 Years 3 Years
Phaco-ECP 19.08 16.03 16.14 16.09 16.03
Phaco Alone 18.16 17.62 16.28 16.87 18.93

23. Phaco-ECP vs Phaco Alone
Complications
No serious complications
were reported in either group
1 patient in each group
developed CME

24. Phaco-ECP vs Phaco Alone
Glaucoma Medication Cost Analysis
Pre-Op Post-Op Savings/Loss
Phaco-ECP monthly patient cost $220.08 $94.78 $125.30
Phaco-ECP annual patient cost $2,640.92 $1,137.35 $1,503.57
Phaco Alone monthly patient cost $144.45 $160.28 ($15.83)
Phaco Alone annual patient cost $1,733.40 $1,923.36 ($189.96)
Estimated US annual savings* $846,765,000
* 2.5 million cataract procedures annually. 20% of cataract surgery patients
concurrently treated with glaucoma medications.

25. Phaco-ECP:
Conclusion
⇒
Hard to get in trouble
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It usually works
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It’s fun!