Cyclodestructive Procedures
Sara Fransen Grace, MD
PREOPERATIVE CONSIDERATIONS
Determine if transscleral diode cyclophotocoagulation (TDC) or endoscopic diode cyclophotocoagulation (ECP) is indicated for the patient. TDC is used for phakic eyes with refractory glaucoma or eyes that are not suited to undergo incisional surgery. ECP should be reserved for eyes that are aphakic or pseudophakic in which external landmarks are not easily identified and an endoscopic view is needed. ECP can be performed concurrently with other intraocular procedures (ie, vitrectomy and posterior capsule membranectomy to clear an opacified visual axis).1,2
Preoperative Examination
Evaluate for scleral thinning as TDC can induce further thinning with possible staphyloma and perforation.
If the ciliary processes cannot be identified well by external landmarks or transillumination, ECP is preferred to TDC.
Evaluate for inflammation. Success rates for these procedures are lower in uveitic eyes.
Due to the risk of sympathetic ophthalmia (however low), cyclodestructive procedures should be avoided in eyes with NLP vision.3
Preoperative Counseling
Discuss the following with the patient’s family to ensure an understanding of the postoperative course:
Treatment may need to be titrated over several sessions to obtain adequate IOP control while avoiding hypotony and vision loss.
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