Since the 1930s, destroying the ciliary body has been a way to treat glaucoma. This method damages the secretory epithelium of the ciliary epithelium. This damage leads to less aqueous humour being made, which lowers the intraocular pressure (IOP).
There are several ways to do cyclodestruction. These include diathermy, surgical excision, cryotherapy, ultrasound, and laser light. Today, a diode laser with a wavelength of 810 nm is often used. It can be applied transsclerally or with an endoscopic probe for cyclocryodestruction.
Key Takeaways
- Cyclocryodestruction has been used to treat glaucoma since the 1930s.
- Cyclodestructive procedures reduce aqueous humour secretion and lower intraocular pressure.
- Diode laser is the most common method for performing cyclocryodestruction.
- Transscleral cyclocryodestruction and endoscopic cyclocryodestruction are widely practised.
- Cyclocryodestruction is indicated for refractory glaucoma, poor visual acuity, and various glaucoma conditions.
Introduction to Cyclocryodestruction
Cyclocryodestruction, also known as cyclodestruction or cyclophotocoagulation, is a surgery to lower eye pressure in glaucoma patients. It freezes the ciliary body, which makes the aqueous humour. This damage cuts down the humour production, lowering eye pressure.
Overview of Cyclocryodestruction Procedure
There are two main ways to do cyclocryodestruction: the transscleral approach (TS-CPC) and the endoscopic approach (ECP). TS-CPC goes through the sclera, while ECP uses an endoscope to reach the ciliary body. Both aim to destroy the ciliary body, reducing humour production and eye pressure.
Benefits and Advantages
- It’s minimally invasive, lowering the risk of problems and speeding up recovery.
- It’s quicker than traditional glaucoma surgeries.
- It can be done in an outpatient setting, often with local anaesthesia.
- It can be repeated to keep eye pressure low, good for advanced glaucoma.
The main benefits of cyclocryodestruction are its minimally invasive nature, shorter procedure time, and quicker recovery. It’s a good option for those with hard-to-treat or advanced glaucoma.
Indications for Cyclocryodestruction
Cyclocryodestruction is a modern treatment for glaucoma. It’s mainly for those with refractory glaucoma or poor vision. This includes people with high eye pressure that can’t be controlled by medicine. It also helps those with scarring from previous eye surgeries.
It’s also for those who can’t have traditional eye surgeries. Cyclocryodestruction treats different types of glaucoma. This includes primary open-angle glaucoma, angle-closure glaucoma, neovascular glaucoma, pseudophakic/aphakic glaucoma, and paediatric glaucoma.
It’s especially good for those with glaucoma with poor vision. It can lower eye pressure and might even improve vision.
| Glaucoma Type | Suitability for Cyclocryodestruction |
|---|---|
| Primary Open-Angle Glaucoma | Suitable |
| Angle-Closure Glaucoma | Suitable |
| Neovascular Glaucoma | Suitable |
| Pseudophakic/Aphakic Glaucoma | Suitable |
| Paediatric Glaucoma | Suitable |
Cyclocryodestruction is a great option for those with refractory glaucoma or glaucoma with poor vision. It can lower eye pressure and might even improve vision.
Surgical Technique
Modern treatments for glaucoma, like diode laser cyclocryodestruction and endocyclophotocoagulation (ECP), are getting more attention. These methods are less invasive than old surgeries. They help lower eye pressure and control glaucoma.
Diode Transscleral Cyclocryodestruction (TS-CPC)
The TS-CPC uses a special laser system with a 810 nm wavelength. A tool called the G probe sends laser energy through the sclera. This targets the ciliary body.
The surgery is done under local anaesthesia because it can hurt. The doctor places laser spots around the eye’s edge. This helps reduce fluid in the eye by damaging the ciliary processes.
Endocyclophotocoagulation (ECP)
ECP is another method that uses a laser probe inserted into the eye. It has a diode laser, a xenon light, and a video monitor. This lets the surgeon see the ciliary processes clearly.
The laser probe is placed in the front chamber of the eye. The doctor treats and coagulates the ciliary processes directly. ECP can be done in different ways, depending on the eye’s condition.
“Cyclocryodestruction with diode laser has become an increasingly recognised treatment for refractory glaucoma, painful glaucoma, neovascular glaucoma, and glaucoma secondary to rhegmatogenous retinal detachment.”
Management and Post-Operative Care
After the cyclocryodestruction procedure, patients start on topical treatments. These include cycloplegics, corticosteroids, and antibiotics for endocyclophotocoagulation. Miotics, which can increase inflammation, are stopped. Glaucoma medications that patients were already taking are kept up and might be reduced based on the procedure’s effect on eye pressure.
Patients are watched closely for any complications after the surgery. They see a doctor the day after for a check-up. Managing glaucoma medication after the procedure is key. This is because the surgery can greatly change eye pressure and the need for more medication.
| Medication Management | Rationale |
|---|---|
| Topical Cycloplegics | To reduce ciliary muscle spasm and pain |
| Topical Corticosteroids | To manage post-operative inflammation |
| Topical Antibiotics (for ECP) | To prevent infection after the procedure |
| Discontinuation of Miotics | To avoid exacerbating the inflammatory response |
| Continuation of Pre-existing Glaucoma Medications | To maintain IOP control, with potential tapering based on the procedure’s effect |
Good care and regular check-ups are vital for the success of cyclocryodestruction and glaucoma medication management.
Complications of Cyclocryodestruction
Cyclocryodestruction is a modern treatment for glaucoma but comes with risks. Patients should know about the possible problems with Diode Transscleral Cyclocryodestruction (TS-CPC) and Endocyclophotocoagulation (ECP).
TS-CPC Complications
The main issues with TS-CPC are pain, hyphema, and iridocyclitis. Other problems include conjunctival burns, hypotony, and vision loss. Rare but serious issues like malignant glaucoma and sympathetic ophthalmia can also happen.
These risks might be higher for those with neovascular glaucoma or past pars plana vitrectomies.
ECP Complications
ECP can lead to fibrin exudates, hyphema, and cystoid macular oedema. Vision loss is also a risk. But, ECP is less likely to cause severe problems like phthisis bulbi and endophthalmitis compared to TS-CPC.
It’s important for patients to be watched closely for these complications. Quick action is key to avoid bad outcomes.
“The most common complications of TS-CPC include pain, hyphema, iridocyclitis, conjunctival burns, hypotony, and vision loss.”
In summary, while cyclocryodestruction is a good option for glaucoma treatment, patients need to be aware of the risks. They should work closely with their doctors to manage and prevent any complications.
Clinical Outcomes
TS-CPC Outcomes
Research on transscleral cyclocryodestruction (TS-CPC) for glaucoma shows mixed results. The pressure inside the eye can drop by 13% to 50%. This change depends on the patient’s history, type of glaucoma, and eye damage.
A study compared slow coagulation TS-CPC with the standard method. It found better eye health in the slow coagulation group. More patients kept their vision better than light-perception. This group also had fewer complications.
Both methods controlled eye pressure well, with 46% and 44% of patients staying below 20 mm Hg. But, the slow coagulation group needed a second procedure more often.
| Outcome Measure | Slow Coagulation TS-CPC | Standard TS-CPC |
|---|---|---|
| Visual Acuity Retention (Better Than Light-Perception) | 71.1% | 65.0% |
| IOP Reduction (IOP | 46% | 44% |
| Mean Number of Complications | 0.62 | 1.46 |
| Need for Second Procedure | 28.8% | 23.1% |
TS-CPC is a good option for glaucoma treatment. The slow coagulation method might offer better vision and fewer complications. But, the choice depends on the patient’s situation and eye health.
Cyclocryodestruction in Paediatric Glaucoma
Cyclocryodestruction, including the transcleral approach (TS-CPC) and endocyclophotocoagulation (ECP), is a good option for kids with glaucoma. It’s especially helpful for those with tough or advanced cases where other surgeries don’t work well.
Choosing the right patient and watching them closely is key when using cyclocryodestruction in kids. There are special challenges and risks, like pain, swelling, and vision problems. So, it’s important to plan well before and after the surgery to get the best results.
A 10-year review shows cyclocryotherapy is promising for kids with glaucoma. The European Glaucoma Society’s 2014 guidelines also have useful stats on cyclocryodestruction for paediatric glaucoma.
Studies by Topouzis F, Yu F, and Coleman AL highlight important points for choosing the right treatment for kids with glaucoma. Kramp K, Vick H-P, and Guthoff R, along with Lin P, Wollstein G, Glavas IP, and Schuman JS, provide more insights into long-term results and how CPC in children with glaucoma compares.
By using the latest in cyclocryodestruction and customizing it for kids, doctors can aim for better vision. This might also mean fewer glasses or contact lenses for these children.
Comparison with Other Glaucoma Treatments
Cyclocryodestruction stands out when compared to other glaucoma surgeries. It’s a less invasive method with quicker recovery and fewer risks. Yet, it might not control eye pressure as well as other surgeries.
Choosing the right treatment depends on many factors. These include the patient’s situation, how severe the glaucoma is, and the doctor’s experience. Cyclocryodestruction is often chosen for cases where other treatments have failed.
| Glaucoma Treatment | Advantages | Disadvantages |
|---|---|---|
| Cyclocryodestruction |
|
|
| Trabeculectomy |
|
|
| Glaucoma Drainage Devices |
|
|
In summary, cyclocryodestruction is a less invasive option with quicker recovery and fewer risks. However, it might not control eye pressure as effectively as traditional surgeries. The best treatment depends on the patient’s needs and the doctor’s expertise.
Conclusion
Cyclocryodestruction is a key treatment for patients with hard-to-treat or advanced glaucoma. It can be done in two ways: through the sclera or endoscopically. This method lowers eye pressure by destroying part of the ciliary body. It also cuts down on the amount of fluid in the eye.
This method is better than old glaucoma surgeries because it heals faster and has fewer risks. It’s especially good for complex glaucoma cases.
Using lasers like Nd:YAG and diode lasers makes the treatment more precise. This leads to less eye inflammation. Newer methods like micropulse and slow-coagulation are also available. They help doctors meet the specific needs of their patients.
The field of cyclocryodestruction is growing, thanks to new research and technology. This approach is becoming more important for treating hard-to-manage glaucoma. It offers a safe and effective way to protect patients’ vision.
FAQ
What is cyclocryodestruction?
Cyclocryodestruction is a surgery to lower eye pressure in glaucoma patients. It freezes the ciliary body to reduce fluid production. This helps lower eye pressure.
What are the key advantages of cyclocryodestruction?
It’s a minimally invasive surgery with a quick recovery. It’s done in an outpatient setting, often with local anaesthesia. This reduces the risk of complications like infection or bleeding.
Who is cyclocryodestruction suitable for?
It’s for those with hard-to-control glaucoma or poor vision. It’s for patients with high eye pressure not helped by medication. It’s also for those who can’t have other surgeries.
What are the different techniques for cyclocryodestruction?
There are two main methods: diode transscleral cyclocryodestruction (TS-CPC) and endocyclophotocoagulation (ECP). TS-CPC uses a laser through the sclera. ECP uses a laser probe inside the eye.
What are the potential complications of cyclocryodestruction?
TS-CPC can cause pain, bleeding, and vision loss. Rare but serious issues include malignant glaucoma and sympathetic ophthalmia. ECP has fewer severe complications like phthisis bulbi and endophthalmitis.
How effective is cyclocryodestruction in lowering intraocular pressure?
TS-CPC’s success varies, with IOP reduction from 13% to 50%. The outcome depends on the patient’s history and eye condition.
Can cyclocryodestruction be used to treat paediatric glaucoma?
Yes, it’s used for kids with glaucoma. It’s effective for those with advanced glaucoma. But, careful selection and monitoring are needed due to the challenges in children.
How does cyclocryodestruction compare to other glaucoma treatments?
It’s less invasive than surgeries like trabeculectomy. It has a quicker recovery and lower risk of complications. But, its effect on eye pressure may not last as long as other surgeries.
