Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options

Abstract

The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.

Efficacy and safety of ultrasonic circular cyclocoagulation with second-generation probe in glaucoma: A retrospective study

“…Assessing the effect of DL-CPC on visual acuity is difficult because this treatment is often used for lost eyes, but it results in 4% of phtisis bulbi, which is intolerable in functional eyes. [28] The small sample size and short follow-up are the main limitations of our study. Although it was a retrospective study, the follow-up was standardized with systematic recording of data and complications.…”

“…[27] DL-CPC allows for a 44% mean reduction in IOP at 19 months in eyes with higher baseline IOP (36 mmHg). [28] In all previous major studies, the procedure was reported as safe without serious intra-or postoperative complications.…”

Comparison of Ultrasound Cycloplasty and Transscleral Cyclophotocoagulation for Refractory Glaucoma in Chinese Population

“…In the past, the standard therapeutic method was cyclocryotherapy. However, this approach exhibits considerable damage to the eye tissue and many complications and incurs signi cant pain to patients, which limits its application in clinical practice [7,8]. Cyclodestructive surgery with LASER energy such as TSCP is a well-established alternative to cyclocryotherapy.…”

Comparison of Ultrasound Cycloplasty and Transscleral Cyclophotocoagulation for Refractory Glaucoma in Chinese Population

“…In the past, the standard therapeutic method was cyclocryotherapy. However, this approach exhibits considerable damage to the eye tissue and many complications and incurs signi cant pain to patients, which limits its application in clinical practice [8,9]. Cyclodestructive surgery with LASER energy such as TSCP is a well-established alternative to cyclocryotherapy.…”