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      Cyclodestructive Procedures

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          Laser cyclophotocoagulation is an accepted method of cyclodestruction, such as cyclocryothermy and the application of cyclodiathermy, microwaves and ultrasound. These procedures may be considered as ultima ratios or ‘last-resort interventions’. Also, in cases where surgery is not possible, cyclodestruction may be the initial intervention. Among other lasers, the Nd:YAG and diode lasers are the energy sources of choice. Contact and noncontact methods have about the same clinical efficiency and risk. While immediate complications are transitory, other, late complications, mentioned in the world literature, such as sympathetic ophthalmia, malignant glaucoma and retinal detachment, are more serious but are rare, and their causal relationship with the cyclodestructive procedure is doubtful. However, they still merit our attention. The ultrastructural mechanisms related to cyclocoagulation have been studied. The study of aqueous flow may improve our understanding of cyclophotocoagulation techniques. Cyclophotocoagulation is considered an important cornerstone in glaucoma therapy. The uncertainty of its effect is no greater than that of any other therapeutic measure in the treatment of glaucoma.

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          Most cited references 6

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          Use of glaucoma drainage devices in the management of glaucoma associated with aniridia.

          To describe intraocular pressure (IOP) and visual acuity outcomes after glaucoma drainage device placement in eyes with glaucoma associated with aniridia.
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            Diode laser cyclophotocoagulation: longer term follow up of a standardized treatment protocol.

             M Walland (2000)
            Diode laser cyclophotocoagulation (cyclodiode) is gaining acceptance as a therapy for refractory or end-stage glaucoma. The aim of the study was to establish whether a reproducible dose-effect relationship exists following a single standardized cyclodiode treatment to lower intraocular pressure (IOP).
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              Transscleral Diode Laser Photocoagulation in Refractory Glaucoma

              Background and Objective: Patients with glaucoma refractory to medical or surgical treatment are difficult to treat. The aim of this study was to evaluate the effect of contact transscleral diode laser cyclophotocoagulation (DLPC) on these patients’ intra-ocular pressure (IOP) and visual acuity. Patients and Methods: 37 eyes of 36 patients who suffered from refractory glaucoma and who had undergone DLPC, were followed at the Eye Clinic of Verona University for an average of 14 ± 4 months. The average age was 54 ± 26 years. IOP, visual acuity and ocular complications were analysed. Results: A total of 71 treatments were given. More than 1 treatment was given in 22 eyes (59%). The mean pretreatment IOP was 33.1 ± 3.3 mm Hg. At the last follow-up, the mean IOP was 21 ± 1.6 mm Hg. Mean total medications were reduced from 4.4 ± 0.5 to 2.4 ± 0.3. No serious complications occurred in 71 treatments. Visual acuity remained stable in 25 eyes (67.5%), improved in 6 eyes (16.2%) and decreased in 6 eyes (16.2%). Conclusions: DLPC is effective in lowering IOP in eyes with refractory glaucoma. It also serves to reduce the number of antiglaucoma medications. This procedure is relatively safe. Nevertheless, multiple DLPC applications may be needed.

                Author and article information

                S. Karger AG
                April 2004
                04 March 2004
                : 218
                : 2
                : 77-95
                aLindenhofspital and bInstitute of Anatomy, University of Berne, Berne, Switzerland
                76142 Ophthalmologica 2004;218:77–95
                © 2004 S. Karger AG, Basel

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                Page count
                Figures: 23, Tables: 4, References: 157, Pages: 19


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