Patients with glaucoma who get micropulse transscleral cyclophotocoagulation might see less inflammation and damage to other eye parts. This new laser method is now the top choice for destroying the ciliary body. It’s a gentle way to handle tough or hard-to-control glaucoma.
Key Takeaways
- Diode laser cyclodestruction is a non-penetrating surgical technique that targets the ciliary body to reduce aqueous humour production and lower intraocular pressure
- The procedure is primarily used for the management of refractory or uncontrolled glaucoma, offering a minimally invasive alternative to traditional incisional glaucoma surgeries
- Micropulse transscleral cyclophotocoagulation (MP-TSCPC) delivers short pulses of energy with rest periods, potentially reducing collateral tissue damage compared to conventional techniques
- Endocyclophotocoagulation (ECP) allows for direct visualisation and treatment of the ciliary processes during cataract surgery
- Careful patient selection and meticulous surgical technique are crucial to optimising outcomes and minimising complications
Introduction to Diode Laser Cyclodestruction
The diode laser cyclodestruction is a well-known treatment for glaucoma. It uses a laser to target the ciliary body. This body is key in making aqueous humour, which helps control eye pressure.
Mechanism of Action
The cyclophotocoagulation (TCP) diode laser works by sending energy at 810 nm. It hits the ciliary processes, causing damage. This damage reduces the amount of aqueous humour made, lowering eye pressure.
Indications for Cyclodiode Laser Therapy
Cyclodiode laser is often used for those who have not responded well to other treatments. It’s especially helpful for neovascular, traumatic, aphakic, silicone-oil induced, inflammatory, and congenital/developmental glaucoma. It’s also being used more as a first choice, even for eyes that can still see well.
This laser is great for those who can’t have surgery or don’t follow treatment plans. It’s a flexible option for many types of glaucoma.
“Cyclodiode laser is seen as a primary treatment option, even in eyes with good visual potential, particularly in developing countries.”
Anatomy and Physiology of the Ciliary Body
The ciliary body is key in the eye, helping to make and control aqueous humour. This clear fluid keeps the eye’s pressure right. It mainly goes out through the trabecular meshwork, but some goes through the uveoscleral outflow too.
The continuous-wave TCP diode laser used in eye treatments targets the ciliary body. This reduces the amount of aqueous humour made, lowering the eye’s pressure. It also helps the uveoscleral outflow, making it easier to manage high eye pressure.
- Among a retrospective case series of 145 eyes, 6.9% developed hypotony after blunt trauma, with only 3 eyes (2%) having a cyclodialysis cleft.
- In the same series, 2 out of the 3 eyes with a cyclodialysis cleft developed clinically significant hypotony.
- The frequency of cyclodialysis cleft formation after surgery is considered to be extremely rare for most procedures.
Knowing how the ciliary body works is important. It helps us understand how diode laser treatments can lower eye pressure. This is useful for many eye problems.
“Topical atropine sulfate 1% is typically applied twice daily for 6 to 8 weeks in cases of a cyclodialysis cleft.”
Surgical Techniques
Diode laser cyclodestruction is a key method for managing eye pressure in patients with glaucoma. It uses two main techniques: transscleral cyclophotocoagulation (TS-CPC) and endocyclophotocoagulation (ECP). These methods target the ciliary body to reduce aqueous humour production.
Transscleral Cyclophotocoagulation (TS-CPC)
TS-CPC uses an 810 nm diode laser. It is applied through a handpiece on the conjunctiva. The treatment involves 16 to 24 laser spots, with power from 1,250 to 2,500 mW and a duration of 2,000 ms.
An alternative slow coagulation technique uses longer durations of 3,500 to 4,500 ms at lower power. It achieves similar success rates.
Endocyclophotocoagulation (ECP)
ECP directly targets the ciliary processes with an 810 nm diode laser. It uses an intraocular endoscopic probe for precise treatment. This method may reduce complications seen with TS-CPC.
| Procedure | Key Parameters | Outcomes |
|---|---|---|
| Transscleral Cyclophotocoagulation (TS-CPC) |
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| Endocyclophotocoagulation (ECP) |
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Other methods like micropulse cyclodiode laser and slow-coagulation continuous-wave cyclodiode laser aim to reduce thermal damage. Ultrasound cycloplasty is also a non-incisional procedure for treating refractory glaucoma.
“Transscleral cyclophotocoagulation and endocyclophotocoagulation have proven to be very effective in lowering intraocular pressure and reducing the number of medications required in patients with refractory glaucoma.”
Equipment and Personnel
The diode laser device used in TS-CPC is small and easy to move. It has a semiconductor laser that sends out energy at 810 nanometres. This laser is connected to a curved handpiece that touches the sclera during the treatment.
For ECP, a special probe is used. It’s an 18-20 gauge tool with an 810 nanometre laser. It also has a xenon light, a helium-neon beam, and a camera for video. This treatment is done in an operating theatre or a special room, with a scrub nurse and/or team helping the surgeon.
At times, a peri/retrobulbar block is given by an anaesthetist if there is one. This helps numb the area for the treatment.
| Equipment | Description |
|---|---|
| TS-CPC Diode Laser Device | Portable, compact unit with semiconductor solid-state diode laser system emitting 810 nm energy, connected to a curved footplate handpiece |
| ECP Probe | 18-20 gauge intraocular instrument with 810 nm diode laser, xenon light source, helium-neon aiming beam, and video imaging camera |
The treatments are done in an operating theatre or a special room. The surgeon works with a scrub nurse and/or team. If there’s an anaesthetist, they might give a peri/retrobulbar block to numb the area.
Preparation for Cyclodiode Laser Treatment
Before starting cyclodiode laser treatment, it’s crucial to pick the right patients. They need to know the treatment’s benefits, risks, and what to expect during recovery. It’s also important to check their overall health, if they can handle anaesthesia, and if they have any eye inflammation.
For those getting endocyclophotocoagulation (ECP) with cataract surgery, a detailed eye check and measurements are needed. This helps pick the right lens for the best vision after surgery.
- Assess patient selection criteria, including general health and ocular status
- Evaluate anaesthesia suitability and address any concurrent inflammation
- Conduct a comprehensive ocular examination and biometry measurements for ECP combined with cataract surgery
Preparing patients well and tackling any issues before the treatment helps doctors achieve the best results. This is key for those getting cyclodiode laser treatment.
“Appropriate patient selection and thorough discussion of potential benefits, risks, recovery expectations, and complications are essential before cyclodiode laser treatment.”
Diode Laser Cyclodestruction Procedure
The diode laser cyclodestruction procedure uses two main methods: transscleral cyclophotocoagulation (TS-CPC) and endocyclophotocoagulation (ECP). These methods use laser energy to target and reduce the production of aqueous humour. This helps lower intraocular pressure.
Transscleral Cyclophotocoagulation Technique
In TS-CPC, the diode laser is set to 1000-2000 mW for 1500-2000 ms. Six spots are applied per quadrant, making a total of 18 spots. The 3 and 9 o’clock positions are avoided. This method aims to damage the ciliary epithelium, reducing aqueous production and lowering intraocular pressure.
Endocyclophotocoagulation Technique
ECP uses a laser setting of 0.2 W in continuous-wave mode. The goal is to whiten and shrink the ciliary processes. It can be done through a limbal or pars plana approach. The latter is better for pseudophakic/aphakic eyes for clearer view of the ciliary processes. This direct treatment of the ciliary body helps control intraocular pressure effectively.
Both TS-CPC and ECP have their advantages in managing refractory glaucoma. The choice depends on the surgeon’s preference and the patient’s needs.
Post-operative Management
After diode laser cyclodestruction, patients follow a specific care plan. This plan helps manage their eye pressure and aids in healing. It includes using postoperative medications and careful IOP management.
Right after the treatment, patients start taking cycloplegics, topical corticosteroids, and antibiotics. They keep taking their pre-laser glaucoma meds but taper them off as needed. Miotics are stopped, and prostaglandin analogues might be stopped too if the eye pressure is good.
It’s very important to keep an eye on the eye pressure after the surgery. Patients often need to see their doctor more often in the first few weeks. This is to check how the eye pressure is doing and adjust the meds if needed. The aim is to keep the eye pressure stable and safe while avoiding any problems.
| Postoperative Medications | Purpose |
|---|---|
| Cycloplegics | Dilate the pupil and reduce inflammation |
| Topical Corticosteroids | Reduce inflammation and promote healing |
| Topical Antibiotics (for ECP) | Prevent infection |
| Pre-laser Glaucoma Medications | Continued and tapered based on IOP response |
Watching and managing IOP closely after surgery is key for success. Patients might need to go back for many visits and have their meds changed to get the eye pressure right.
Complications of Diode Laser Cyclodestruction
Diode laser cyclodestruction is a treatment for glaucoma but comes with risks. Success rates vary from 38% to 85%. This shows the importance of choosing the right patients and using the right technique.
Transscleral Cyclophotocoagulation Complications
TS-CPC can lead to several problems. These include pain, hyphema, iridocyclitis, and burns to the conjunctiva. Other issues are hypotony, vision loss, phthisis bulbi, and even sympathetic ophthalmia. To avoid these, it’s crucial to pick the right patients and use precise techniques. Close monitoring after the surgery is also key.
Endocyclophotocoagulation Complications
ECP tends to have fewer complications than TS-CPC. Possible issues include fibrin exudates, hyphema, cystoid macular edema, and vision loss. But, ECP is generally safer, making it a better choice for some patients.
To reduce risks and improve results, it’s vital to carefully choose patients. Use precise surgical methods and keep a close eye on patients after surgery. This approach helps in avoiding complications and achieving better outcomes for those undergoing diode laser cyclodestruction.
Conclusion
Diode laser cyclodestruction is a safe and effective way to control eye pressure in advanced glaucoma. It works well in the short and medium term. The treatment can be adjusted to get the best results and avoid problems.
Studies show it can lower eye pressure a lot, with 90.9% of eyes seeing a drop. Also, the need for eye drops went down from 3.30 to 2.67. Though some issues like low eye pressure and more surgery were seen, it’s still a good choice for refractory glaucoma.
With more angle-closure glaucoma cases, especially in Asia, this treatment is becoming more important. Doctors need to think about each patient’s needs to choose the best treatment. This way, they can get the best results from diode laser cyclodestruction for eye pressure.
FAQ
What is diode laser cyclodestruction?
Diode laser cyclodestruction is a surgery for glaucoma. It uses a laser to reduce eye pressure. This is done by partially destroying the ciliary body, which makes fluid in the eye.
What are the key indications for diode laser cyclodestruction?
It’s for people with glaucoma that’s hard to control. This includes different types of glaucoma. It’s used when other treatments haven’t worked.
How does diode laser cyclodestruction work to lower intraocular pressure?
The laser emits energy at 810 nm. This damages the ciliary epithelium. This damage reduces fluid production and increases fluid outflow, lowering eye pressure.
What are the different techniques for diode laser cyclodestruction?
There are two main methods. Transscleral cyclophotocoagulation (TS-CPC) uses the sclera. Endocyclophotocoagulation (ECP) uses an endoscope for direct targeting.
What equipment and personnel are involved in diode laser cyclodestruction procedures?
The surgery is done in an operating theatre. An ophthalmic surgeon and a scrub nurse assist. An anaesthetist may also be present.
How do you prepare a patient for diode laser cyclodestruction?
Patients must understand the procedure’s benefits and risks. Their health and eye condition are checked before surgery. For ECP, eye exams and measurements are needed if cataract surgery is planned.
What are the common complications associated with diode laser cyclodestruction?
TS-CPC can cause pain, bleeding, and vision loss. ECP has fewer complications but can still cause vision problems and bleeding. Both methods can lead to serious eye issues.
