**16. Ciliary body endophotocoagulation (ECP)**

Photocoagulation of the ciliary body processes is done by a 810 nm semiconductor diode laser. The endoscope carries the viewing system, the laser system and the light source. The procedure can be applied via a pars plana approach or from corneal incision. The treatment is applied over 360°. When it is delivered through a corneal incision it can follow phacoemulsification as the removal of the crystalline lens offers easier access to the ciliary processes. The probe is pushed forward between the intraocular lens implant and the iris

#### **16.1. Outcomes**

Phaco-ECP provides good control of the IOP in early/moderate glaucoma over time with no ECP related complications [115]. This study also suggests that phaco-ECP offers an additional hypotensive effect to phacoemulsification alone. Lima et al compared ECP with Ahmed GDD in the treatment of refractory glaucoma and found no differences in the success rate. Ahmed GDD had a higher complication rate than ECP [116].

#### **17. Summary**

Phaco-trabeculectomy remains the standard procedure for the management of coexisting cataract and glaucoma. Newer techniques have been developed in order to avoid entering the eye and provide a more controlled reduction of the IOP. The use of antifibrotic agents have improved the survival of these procedures but also increased the incidence of complications. On the other hand the development of the newer antiglaucoma drops gave more options to the ophthalmologists for the medical management of glaucoma but have adversely affected the outcome of the antiglaucoma surgery.

The glaucoma drainage implants retain their place as a useful tool in many forms of severe glaucoma where the penetrating and non-penetrating procedures are likely to fail. The Ex-PRESS mini implant is a penetrating procedure but has a better safety profile and equal hypotensive effect to trabeculectomy.

Current research aims to the development of miniature devices that will facilitate the drainage of aqueous via the physiological pathways without leading to aqueous accumulation under the external coatings of the eye.
