Over the past six decades, cyclodestructive techniques have been used in glaucomatous eyes with intraocular pressure (IOP) uncontrolled by medication and/or incisional surgery. With the advances of endoscopic imaging and laser technology, greater tissue specificity can be achieved with the modern diode laser, resulting in IOP-lowering effect with less tissue damage. The indications, techniques, outcomes, and potential complications for both transscleral and endoscopic cyclophotocoagulation are described in this chapter.
KeywordsTransscleral Endoscopic Cyclophotocoagulation Cyclodestruction Childhood Pediatric Glaucoma Refractory Ciliary processes
The authors thank Dr. Anna Junk (Bascom Palmer Eye Institute, Miami Veterans Affairs Healthcare System, Miami FL, USA) for sharing her intraoperative video of endocyclophotocogulation.
Transscleral cyclophotocoagulation . The footplate of the laser probe is placed at the limbus, while laser is activated by a foot pedal and applied to the ciliary body. A pair of fine-toothed forceps helps to rotate the eye during the procedure (MP4 13975 kb)
Endoscopic cyclophotocoagulation . The tip of the endoprobe is positioned from the ciliary body such that about four to five ciliary processes are visible on the screen at any given time. Laser is applied to the ciliary processes until shrinkage and whitening occur without rupture of ciliary processes or bubble formation. (Courtesy of Anna K. Junk, MD, Bascom Palmer Eye Institute, University of Miami, Miami FL, USA) (© Anna K. Junk) (MOV 4978 kb)
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