Another Look on Cyclodestructive Procedures

Cycloablation is a destructive procedure used to decrease the intra-ocular pressure (IOP) trough the ablation of the ciliary body that produces aqueous humour. Many destructive techniques, including diathermy, cryotherapy, ultrasounds, beta irradiation, and laser photocoagulation have been employed with a wide range of results and side effects. Although all above techniques can effectively destroy the ciliary body, only few of them have been used widely enough to convincingly demonstate their clinical usefulness and gain general acceptance. The ideal method of cyclodestruction should produce clinically useful and predictable reduction of intraocular pressure (IOP), with minimal complications and side effects. (Bartamian & Higginbotham, 2001). Ideally it should have a wide therapeutic window between insufficient and too aggressive treatment intensity, that can result in either insufficient IOP reduction or hypotony/phtisis. Cyclodestructive procedures are usually reserved for cases of glaucoma in eyes with little or no visual potential that proved refractory to medical treatment and outflow surgeries. (Lin, 2008) As an exception to this long established indication, cyclodestructive procedures performed with the 810 nm infrared diode laser transscleral cyclophotocoagulation have been successfully applied also in eyes with refractory glaucoma and good visual potential (Rotchford et al., 2010; Wilensky & Kammer, 2004) supporting an emerging notion that the indications for transscleral laser cyclophotocoagulation should not be limited to eyes with poor visual acuity or potential.