Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options

Adv Ther. 2018 Dec;35(12):2103-2127. doi: 10.1007/s12325-018-0837-3. Epub 2018 Nov 17.

Abstract

The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.

Keywords: Cyclocryotherapy; Cyclodestruction; Cyclophotocoagulation; Diode laser; Endoscopic photocoagulation; High-intensity focused ultrasound; Micropulse diode; Ophthalmology; Refractory glaucoma; Ultrasound cyclodestruction.

Publication types

  • Review

MeSH terms

  • Aqueous Humor
  • Cryotherapy / adverse effects
  • Cryotherapy / methods
  • Endoscopy / methods
  • Glaucoma / pathology*
  • Glaucoma / surgery*
  • High-Intensity Focused Ultrasound Ablation / adverse effects
  • High-Intensity Focused Ultrasound Ablation / methods
  • Humans
  • Intraocular Pressure
  • Laser Coagulation / adverse effects
  • Laser Coagulation / methods
  • Lasers, Semiconductor / adverse effects
  • Lasers, Semiconductor / therapeutic use
  • Light Coagulation / adverse effects
  • Light Coagulation / methods
  • Ophthalmologic Surgical Procedures / adverse effects
  • Ophthalmologic Surgical Procedures / methods*
  • Severity of Illness Index
  • Treatment Outcome

Associated data

  • figshare/10.6084/m9.figshare.7291136