Transscleral cyclophotocoagulation (TSCPC) is a non-incisional laser procedure that manages glaucoma, a condition with elevated pressure inside the eye. It reduces the amount of fluid the eye produces, similar to turning down a running faucet. Its objective is to lower intraocular pressure, protecting the optic nerve from damage.
When is This Procedure Recommended?
This procedure is considered for challenging glaucoma cases when other treatments have not achieved sufficient pressure control. Doctors recommend TSCPC when glaucoma is severe or has not responded adequately to medications or prior surgical interventions (refractory glaucoma). It is also an option when the eye has limited visual potential, aiming to alleviate pain and control eye pressure.
TSCPC is suitable for various types of glaucoma, including neovascular glaucoma (resulting from abnormal blood vessel growth) and inflammatory glaucoma. It is also considered for patients unsuitable for more invasive surgeries or those who prefer a laser-based approach. This treatment is reserved when conventional filtering surgeries or glaucoma drainage devices are unfeasible or likely to fail.
The Surgical Process
Preparation involves ensuring patient comfort. Anesthesia, typically a local injection (e.g., retrobulbar or peribulbar block), numbs the area, minimizing discomfort.
During the procedure, an 810 nm diode laser probe is placed on the sclera (outside surface of the eye) without incisions. Laser energy passes through the sclera to target the ciliary body, which produces aqueous humor, reducing fluid production. The entire process usually takes 10 to 15 minutes.
Recovery and Post-Procedure Care
Immediately following the procedure, an eye patch may be applied for 24 hours for protection and healing. Patients can expect initial discomfort, managed with prescribed pain medication. Redness and swelling are normal during initial recovery.
A medication regimen is part of post-operative care. This involves intensive anti-inflammatory eye drops (often steroids) to control swelling and pain. Antibiotic eye drops may also be prescribed to minimize infection risk. Patients may also experience temporary blurred vision and light sensitivity, which improve over time.
Regular follow-up appointments with the ophthalmologist monitor healing progress and intraocular pressure. The first follow-up often occurs the day after. Patients are advised to avoid strenuous activities, bending forward, or touching the treated eye to prevent complications.
Outcomes and Potential Complications
The primary goal of TSCPC is to significantly reduce intraocular pressure, helping to preserve vision. Success rates vary, and some individuals may require multiple treatment sessions to reach target eye pressure. Studies indicate a common outcome is at least a 20% reduction in intraocular pressure from baseline.
While inflammation, pain, and temporary vision changes are expected during recovery, more serious complications can occur. These include hypotony (eye pressure becoming too low), reported in approximately 1.8% to 3.7% of cases. Other complications include chronic inflammation, reduced vision, and, rarely, phthisis bulbi (where the eye shrinks and loses function). Phthisis bulbi incidence is very low, around 0.5%.
A newer approach, Micropulse cyclophotocoagulation (MP-TSCPC), reduces tissue damage and lowers complication risk. Unlike traditional continuous-wave laser delivery, MP-TSCPC delivers laser energy in short bursts with “off” periods, allowing tissue to cool. This pulsatile energy delivery minimizes collateral thermal injury, potentially leading to a more favorable safety profile.