Tanito Masaki
Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN.
Cureus. 2025 Jul 10;17(7):e87693. doi: 10.7759/cureus.87693. eCollection 2025 Jul.
Endoscopic cyclophotocoagulation (ECP), originally developed for the treatment of refractory glaucoma, has seen expanding use in recent years as a minimally invasive glaucoma surgery (MIGS), particularly when combined with cataract extraction. ECP reduces intraocular pressure (IOP) by suppressing aqueous humor production through targeted ablation of the ciliary processes under endoscopic guidance. This contrasts fundamentally with outflow-enhancing MIGS, which aim to restore impaired physiological function. Theoretical modeling suggests that reductions in aqueous production following ECP may approximate changes that occur over several decades of natural aging. While ECP spares the conjunctiva and is repeatable, its irreversible suppression of aqueous production may raise long-term physiological concerns. Given that aqueous humor supports the metabolic environment of anterior segment structures, sustained suppression may impact ocular homeostasis. Although clinically noteworthy complications remain rare, the growing use of ECP in non-refractory cases necessitates careful consideration. Especially as green-laser ECP is newly introduced in Japan and primarily used for refractory glaucoma, I believe it is important to revisit the fundamental differences between outflow- and inflow-targeting procedures and evaluate the broader implications of routine ECP application across glaucoma stages.
内镜睫状体光凝术（ECP）最初是为治疗难治性青光眼而开发的，近年来作为一种微创青光眼手术（MIGS），其应用范围不断扩大，尤其是与白内障摘除术联合使用时。ECP通过在内镜引导下对睫状体进行靶向消融来抑制房水生成，从而降低眼压（IOP）。这与旨在恢复受损生理功能的增加房水流出的MIGS形成了根本对比。理论模型表明，ECP后房水生成的减少可能与自然衰老几十年中发生的变化相似。虽然ECP保留了结膜且可重复进行，但其对房水生成的不可逆抑制可能会引发长期的生理问题。鉴于房水支持眼前段结构的代谢环境，持续抑制可能会影响眼内稳态。尽管临床上值得注意的并发症仍然很少见，但ECP在非难治性病例中的使用日益增加，这需要仔细考虑。特别是在日本新引入绿色激光ECP且主要用于难治性青光眼的情况下，我认为重新审视针对房水流出和流入的手术之间的根本差异，并评估常规ECP应用于青光眼各阶段的更广泛影响非常重要。
