Cyclodestructive Procedures for Glaucoma

Cyclodestructive Procedures for Glaucoma

Marisse M. Solano

Shan C. Lin

Geoffrey P. Schwartz

Louis W. Schwartz


Intraocular pressure is the major risk factor for glaucoma that ophthalmologists are able to control. Medically, either eye drops or pills are used to decrease aqueous production or increase aqueous outflow to effectively lower intraocular pressure. Most surgical and laser procedures, including trabeculectomy, tube shunts, goniotomy, iridectomies, laser trabeculoplasty, and laser iridotomy, decrease the intraocular pressure by increasing outflow. Cyclodestructive procedures are designed to destroy the ciliary processes, thereby decreasing aqueous production. Because of the unpredictability of these procedures in lowering intraocular pressure and the complications associated with their use, such cyclodestructive procedures are often considered a surgery of last resort. However, recent studies and practices have employed these procedures as a first-line surgery and even before medication treatment.


Several techniques are used for cyclodestruction. They include noncontact transscleral CPC, contact transscleral CPC, MP TCP, cyclocryotherapy, transpupillary CPC, and ECP. All of the procedures may be repeated and the nonpenetrating forms may often require multiple treatments.


• A neodymium (Nd):YAG laser is used to perform noncontact CPC. In the past, a semiconductor diode laser, Microlase (Keeler, Inc., Broomall, PA), was also utilized.1

• Retrobulbar anesthesia is given.

• A lid speculum is placed if a contact lens is not used.

• A contact lens developed by Bruce Shields may or may not be used. The contact lens has the advantages of having markers at 1-mm intervals to better judge the distance from the limbus, blocking some of the laser light from entering the pupil, and blanching an inflamed conjunctiva to decrease superficial charring of the conjunctiva2 (Fig. 27-1).

• Eight to 10 burns are placed 1 to 3 mm (optimal: 1.5 mm) from the limbus for 180 to 360 degrees, taking care to avoid the 3 and 9 o’clock meridians in order to avoid coagulating the long posterior ciliary arteries and causing anterior segment necrosis. Energy levels of 4 to 8 J are used. The laser beam is focused on the conjunctiva; however, the laser is defocused such that its effect is actually 3.6 mm beyond the conjunctival surface, with most of the energy being absorbed by the ciliary body (Fig. 27-2). In general, the greater the energy levels used, the greater is the inflammation.3,4,5


1. Hennis HL, Stewart WC. Semi-conductor diode laser transscleral cyclophotocoagulation in patients with glaucoma. Am J Ophthalmol. 1992;113:81-85.

2. Simmons RB, Blasini M, Shields MD, et al. Comparison of transscleral neodymium:YAG cyclophotocoagulation with and without a contact lens in human autopsy eyes. Am J Ophthalmol. 1990;109:174-179.

3. Frankhauser F, Van der Zypen E, Kwasniewska S, et al. Transscleral cyclophotocoagulation using a neodymium YAG laser. Ophthalmic Surg Lasers. 1986;1:125-141.

4. Schwartz LW, Moster MR. Neodymium:YAG laser transscleral cyclodiathermy. Ophthalmic Laser Ther. 1986;1:135-141.

5. Crymes BM, Gross RL. Laser placement in noncontact Nd:YAG cyclophotocoagulation. Am J Ophthalmol. 1990;110:670-673.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

May 4, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Cyclodestructive Procedures for Glaucoma

Full access? Get Clinical Tree

Get Clinical Tree app for offline access