Endoscopic Cyclo-Photocoagulation (ECP) is a way to use a laser for partial cyclo-destruction so that less aqueous is produced and therefore the intra-ocular pressure becomes lower in an effort to treat glaucoma. ECP can be performed from an anterior approach such as this video where it is done along with cataract surgery or it can be done via pars plana with a complete vitrectomy. When the capsular bag is filled with viscoelastic and the IOL is inserted, additional aliquots of cohesive (or super-cohesive) viscoelastic is injected under the iris to expand the ciliary sulcus. The ECP probe has a lighting system, a camera, and the laser aperture. Generally the ECP probe is placed about 2 mm away from the ciliary processes and then the laser is fired to create whitening of the tissue. This can be done for about 270 degrees if using the main phaco incision or even 360 degrees if using two paracenteses incisions placed opposite each other. We can also perform ECP in combination with another glaucoma procedure such as angle-based MIGS.
