Cyclodestruction refers to a technique that reduces intraocular pressure by damaging the aqueous producing part of the ciliary body. The approach has widely been used in the treatment of glaucoma for almost a century.
Ciliary bodies are known to regenerate, and for this reason, more than one treatment may be necessary for some patients. There exist several ways of destroying ciliary bodies such as cryotherapy, laser lights, and diathermy.
Surgical excision and diathermy were the earliest forms of treating refractory glaucoma. After technical demands and safety issues with the modalities, scientists introduced cryotherapy, ultrasound, and laser lights as more satisfactory forms of treatment.
Cyclodestruction mainly aims to treat refractory glaucoma by reducing the production of aqueous humor and reducing pain.
Also Known As
- Ciliary body ablation
Cycloablation employs three basic approaches, namely:
- Ultrasound cyclodestruction
Before the Procedure
An appointment with the doctor would be essential to learn about the benefits and risks of the procedures. During the session, the patient should notify the doctor of any medical conditions or reactions.
The doctor may take some eye measurements in preparation for the procedure. If the patient is on glaucoma medication, the ophthalmologist may advise that they continue with medication until surgery.
Most of the surgeries happen as outpatient procedures. It will be important for the patient to have a responsible relative or friend to drive them home.
The procedure involves the following;
- Using a clean cloth, the ophthalmologist cleans the eye to prepare it for treatment.
- While in a lying position, the doctor numbs the eye using local anesthesia. In the case of anxiety, the patient may receive general anesthesia.
- In trans-scleral cyclophotocoagulation, the ophthalmologist moistens the eye's surface using a saline solution. S/he then places the probe at the white of the eye and transmits energy through it.
- The probe moves around while avoiding areas that would cause injuries to the long posterior nerves. The doctor increases power until there is a production of a pop sound, which indicates over treatment. After that, s/he reduces the laser energy and completes the treatment.
- Before conducting an endoscopic cyclophotocoagulation (ECP), the doctor will need to ensure the diode laser, monitor, and light source are correctly set up.
- After administering anesthesia, the surgeon may make an incision in the cornea to direct the probe to the sulcus. While viewing the monitor, s/he orients through the sulcus to find the target organ.
- The doctor then continuously transmits laser energy to the ciliary processes to shrink and whiten them. Viscoelastic removal follows to prevent post-surgery increased intraocular pressure.
- For cyclocryotherapy, the doctor proceeds to locate the ciliary body using lighted equipment. After locating it, s/he directs a cryoprobe to the sclera several times and in a clockwise manner. While directing the cryoprobe, the doctor carefully avoids the area where extraocular muscles connect to the eye.
Risks & Complications
Cyclodestruction is associated with a variety of risks. Patients may experience laser burns as a result of either a dry conjunctiva or a faulty laser probe. Improper application of the probes may also cause injuries to the Iris. Overtreatment, bleeding, and retinal detachment may also occur.
A common side effect of cyclodestruction is pain. It is mainly experienced moments after surgery. Some patients may also experience a blurry vision and increased sensitivity to light.
The major complication with cycloablation is phthisis bulbi, a condition that results from overtreatment. In severe instances, vision loss may occur.
Aftercare & Recovery
Some of the home care routines may include;
- Use of pain relievers to curb pain
- Ointment application to prevent infections that may spring up from injuries
- Engaging in less strenuous activities
- Wearing sunglasses while outside
- Getting enough rest
- Avoiding constant eye touching and rubbing
- Follow up visit to the hospital as directed by the doctor
Recovery from the procedure may take approximately six to eight weeks. After this period, the patient can resume normal activities.
The result of a cyclodestruction is reduced pain and intraocular pressure. However, the production of aqueous humor may be significantly low, except for endoscopic cyclophotocoagulation, hence the need for further treatment.