Intraocular Cyclophotocoagulation

Fasanella

Journal of Ophthalmology

et al. 2017

The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC3), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC3 shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC3 was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC3, summarizing the current knowledge about this procedure and future possible developments.

Section: Cyclodestructive Techniquesmentioning

confidence: 99%

Section: Miniaturized High-intensity Focused Ultrasounds For Cyclomentioning

confidence: 99%

High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction?

Fasanella

Journal of Ophthalmology

et al. 2017

European Journal of Ophthalmology

“…Transscleral cyclophotocoagulation has traditionally been used as a last-resort method to lower intraocular pressure (IOP) when all other medical and surgical treatments have failed, and has been associated with risk of marked inflammation, hypotony, and phthisis (1, 2). Endoscopic cyclophotocoagulation (ECP) was first introduced by Shields (3) in 1986 as an alternative tool in the armamentarium of glaucoma treatment. This combines a diode endolaser and an endoscope with a light source in a single probe, which allows visualization of the ciliary processes.…”

Section: Introductionmentioning

confidence: 99%

Phacoemulsification plus endoscopic cyclophotocoagulation versus phacoemulsification alone in primary open-angle glaucoma

Bartolomé

Rodrigues

Saurabh

et al. 2018

“…Endoscopic photoablation of ciliary processes was first described by Shields in 1985. 1 2 It was soon apparent that an endoscopic approach resulted in more controllable and focal tissue effects than transscleral ‘cyclodiode’. 3 Diode laser delivery via the transscleral route is inefficient, with only 35% of laser energy reaching its intended target.…”

Section: Introductionmentioning

confidence: 99%

‘Phaco–ECP’: combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma

2012

ObjectivesDoes phaco–ECP reduce intraocular pressure? Is phaco–ECP safe?DesignRetrospective case note review of all patients undergoing phaco–ECP between June 2008 and June 2009. All glaucoma subtypes were included.SettingSingle District General Hospital Ophthalmology Department within the UK.Participants58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8).InterventionsAll patients received combined cataract surgery and endoscopic cyclophotocoagulation.Outcome measuresFollow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed.ResultsOf the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout.ConclusionsThis study confirms the safety of phaco–ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco–ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm Hg) are indicated.