Cyclophotocoagulation is a laser procedure designed to manage eye pressure, primarily for individuals with glaucoma. This treatment utilizes focused laser energy to reduce the production of fluid within the eye, thereby lowering intraocular pressure (IOP). It serves as an option to help prevent further damage to the optic nerve caused by elevated eye pressure. This procedure is performed by an ophthalmologist.
Understanding Cyclophotocoagulation
The eye continuously produces a clear fluid called aqueous humor, which nourishes the eye’s structures. This fluid is made by the ciliary body, a structure located behind the iris. In a healthy eye, aqueous humor drains out through a natural drainage system, maintaining a balanced pressure.
When this drainage system does not function properly, or too much fluid is produced, intraocular pressure can increase. Cyclophotocoagulation targets the ciliary body to reduce the amount of aqueous humor produced. The laser energy is absorbed by the pigmented cells of the ciliary body, causing a controlled alteration of the tissue.
This alteration leads to a decrease in the ciliary body’s ability to produce fluid, thereby lowering the pressure inside the eye. The effects of the procedure can be temporary as the ciliary processes may regenerate, sometimes requiring repeat treatments.
When is Cyclophotocoagulation Recommended?
Cyclophotocoagulation is considered for individuals with glaucoma when other treatments have not been successful in controlling intraocular pressure. This includes cases where medications or less invasive laser procedures have not achieved the desired pressure reduction. It is commonly used for refractory glaucoma, which means the glaucoma is difficult to manage with conventional therapies.
This procedure is also an option for patients with poor visual potential in whom the risks of incisional surgery might outweigh the benefits. While traditionally reserved for advanced cases or eyes with limited vision, newer techniques are increasingly considered earlier in the treatment pathway. However, certain conditions, like uveitic glaucoma, can be a contraindication due to the risk of worsening inflammation.
The Procedure Explained
Cyclophotocoagulation is performed as an outpatient procedure, meaning you can go home the same day. Before the procedure begins, the eye is numbed using a local anesthetic, which may involve an injection around or behind the eye. In some cases, “twilight” anesthesia may also be administered.
Two main approaches are: transscleral cyclophotocoagulation (TSCPC) and endoscopic cyclophotocoagulation (ECP). In TSCPC, a laser probe is placed on the surface of the white part of the eye (sclera), about 1 to 2 mm behind the limbus (the edge of the cornea). The laser energy passes through the sclera to reach the ciliary body without requiring an incision into the eye. Laser spots are applied.
For ECP, a small incision is made at the edge of the cornea. A tiny endoscope is inserted into the eye, allowing the surgeon to directly visualize the ciliary processes on a monitor. The laser energy is then precisely applied to these processes. The entire procedure usually takes about 10 to 15 minutes.
Post-Procedure Care and Outcomes
Following cyclophotocoagulation, you can expect some discomfort, which may last for several days. Your vision may be blurry initially, improving over one to two weeks, though sometimes it can take longer. It is common to experience some inflammation in the treated eye, such as redness or swelling.
To manage discomfort and reduce inflammation, your doctor will likely prescribe anti-inflammatory and antibiotic eye drops, which you will need to use as directed. A clear plastic shield or patch may be recommended to protect the eye, especially during sleep, for about one week. Wearing sunglasses outdoors is also advisable.
Follow-up appointments are scheduled, usually starting the day after the procedure, then about a week later, and again in a few weeks, to monitor your eye pressure and healing progress. The full effect of the treatment on eye pressure may take up to a month to become apparent. The goal is to lower eye pressure, typically by 20 to 30 percent.
While effective, the ciliary processes can regenerate, meaning repeat treatments may be necessary over time to maintain pressure control. Potential side effects can include pain, increased light sensitivity, or temporary elevation of intraocular pressure. Complications include persistent inflammation, bleeding inside the eye, swelling in the back of the eye (cystoid macular edema), or hypotony, where the eye pressure becomes too low. Severe complications like significant vision loss or phthisis bulbi (shrinking of the eye) can occur.