Abstract
Cyclodestructive techniques have been a treatment option for refractory glaucoma since its first use in the 1930s. Over the past nine decades, cyclodestruction has advanced from the initial cyclodiathermy to micropulse transscleral cyclophotocoagulation (MP-TSCPC) which is the current treatment available. Complications associated with cyclodestruction including pain, hyphema, vision loss, hypotony and phthisis have led ophthalmologists to shy away from these techniques when other glaucoma treatment options are available. Recent studies have shown encouraging clinical results with fewer complications following cyclophotocoagulation, contributing greatly to the current increase in the use of cyclophotocoagulation as primary treatment for glaucoma. We performed our literature search on Google Scholar Database, Pubmed, Web of Sciences and Cochrane Library databases published prior to September 2017 using keywords relevant to cyclodestruction, cyclophotocoagulation and treatment of refractory glaucoma.
Highlights
Since the 1930s, cyclodestruction has been a treatment option offered to such patients to lower intraocular pressure (IOP) and slow the progression of glaucoma.[2,4,5]
Over the past nine decades, the search for treatment options which would provide better focused energy and targeted destruction of the ciliary processes has led to an increase in cyclodestructive treatment options, decrease in collateral tissue destruction and postoperative outcomes comparable to other glaucoma treatment modalities
A long‐term follow‐up of 500 patients treated with noncontact transscleral Neodymium: Yttrium‐Aluminum‐Garnet (Nd):YAG CPC found that compared with cyclodiathermy and cyclocryotherapy, transscleral Nd:YAG CPC was associated with less transient IOP elevation, less ocular inflammation and less pain.[3]
Summary
Quick Response Code: Website: www.jovr.org glaucoma.[2]. Over the past nine decades, the search for treatment options which would provide better focused energy and targeted destruction of the ciliary processes has led to an increase in cyclodestructive treatment options, decrease in collateral tissue destruction and postoperative outcomes comparable to other glaucoma treatment modalities. During TSCPC, the laser beam transmitted through the overlying sclera is absorbed by melanin in the ciliary processes, leading to selective thermal coagulation of ciliary body tissues Easy application of this approach, improved energy delivery and focusing system, and reproducibility of outcome is contributory to its widespread use.[37] Historically, because of its high rate of complications, TSCPC has been a treatment of last resort in functional eyes with advanced glaucoma when other treatment options are exhausted.[36] It provides a treatment option for patients who are medically unfit for invasive surgical procedures or patients who have refused incisional surgery.[36] TSCPC can be used to mitigate ocular pain in patients who present with a painful blind eye and markedly elevated IOP.[36] Nd:YAG laser (1064 nm) and semiconductor diode laser (810 nm) can be used in contact or non‐contact techniques. Retrobulbar bupivacaine and sub–Tenon’s injection of 1 mL of triamcinolone (40 mg/ml) is usually administered at the end of the procedure to minimize postoperative pain and inflammation respectively
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