Skip to main content
PMC home page
Transactions of the American Ophthalmological Society logoLink to Transactions of the American Ophthalmological Society
. 1985;83:285–303.

Cyclodestructive surgery for glaucoma: past, present, and future.

M B Shields
PMCID: PMC1298702  PMID: 3832531

Abstract

When surgical attempts to control glaucoma by improving aqueous outflow are not successful, the alternative approach is usually to reduce aqueous inflow by a cyclodestructive procedure. Cyclodestructive elements that have been tried in the past include diathermy, electrolysis, and beta irradiation. Cyclocryotherapy is presently the most commonly used cyclodestructive procedure, although this operation has significant limitations, and newer techniques are being evaluated utilizing laser energy or ultrasonic radiation. Each of these procedures uses a transcleral approach, which has the disadvantages of (1) the inability to precisely quantitate the destruction of the ciliary processes, and (2) damage to adjacent tissue. Transpupillary cyclophotocoagulation minimizes these problems, but is limited to the small number of eyes in which adequate gonioscopic visualization of the ciliary processes can be achieved. An alternative approach for aphakic eyes is intraocular cyclophotocoagulation, utilizing an endophotocoagulator through a pars plana incision. Depending on the status of the eye, visualization for this technique can be accomplished either by the transpupillary route or with an endoscope.

Full text

PDF
285

Images in this article

290FIGURE 1
on p.290
291FIGURE 2
on p.291
293FIGURE 3
on p.293
294FIGURE 4
on p.294
295FIGURE 5
on p.295
296FIGURE 6
on p.296

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BERENS C., SHEPPARD L. B., DUEL A. B. Cycloelectrolysis for glaucoma. Trans Am Ophthalmol Soc. 1949;47:364–382. [PMC free article] [PubMed] [Google Scholar]
  2. BIETTI G. Surgical intervention on the ciliary body; new trends for the relief of glaucoma. J Am Med Assoc. 1950 Mar 25;142(12):889–897. doi: 10.1001/jama.1950.02910300027006. [DOI] [PubMed] [Google Scholar]
  3. BUTTERWORTH R. F., BIGNELL J. L. A new type of eye endoscope. Br J Ophthalmol. 1952 Apr;36(4):217–220. doi: 10.1136/bjo.36.4.217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bartl G., Haller B. M., Wochesländer E., Hofmann H. Licht- und elektronenmikroskopische Ergebnisse nach Photokoagulation der Ziliarkörperzotten mit dem Argonlaser. Klin Monbl Augenheilkd. 1982 Nov;181(5):414–416. doi: 10.1055/s-2008-1055263. [DOI] [PubMed] [Google Scholar]
  5. Beckman H., Kinoshita A., Rota A. N., Sugar H. S. Transscleral ruby laser irradiation of the ciliary body in the treatment of intractable glaucoma. Trans Am Acad Ophthalmol Otolaryngol. 1972 Mar-Apr;76(2):423–436. [PubMed] [Google Scholar]
  6. Beckman H., Sugar H. S. Neodymium laser cyclocoagulation. Arch Ophthalmol. 1973 Jul;90(1):27–28. doi: 10.1001/archopht.1973.01000050029006. [DOI] [PubMed] [Google Scholar]
  7. Beckman H., Waeltermann J. Transscleral ruby laser cyclocoagulation. Am J Ophthalmol. 1984 Dec 15;98(6):788–795. doi: 10.1016/0002-9394(84)90699-8. [DOI] [PubMed] [Google Scholar]
  8. Bellows A. R., Grant W. M. Cyclocryotherapy of chronic open-angle glaucoma in aphakic eyes. Am J Ophthalmol. 1978 May;85(5 Pt 1):615–621. doi: 10.1016/s0002-9394(14)77093-x. [DOI] [PubMed] [Google Scholar]
  9. Bernard J. A., Haut J., Demailly P. h., Hamelin B., Offret G. Coagulation des procés ciliaires au laser á l'argon. Son utilisation dans certaines hypertonies. Arch Ophtalmol Rev Gen Ophtalmol. 1974 Aug-Sep;34(8-9):577–580. [PubMed] [Google Scholar]
  10. Binder P. S., Abel R., Jr, Kaufman H. E. Cyclocryotherapy for glaucoma after penetrating keratoplasty. Am J Ophthalmol. 1975 Mar;79(3):489–492. doi: 10.1016/0002-9394(75)90626-1. [DOI] [PubMed] [Google Scholar]
  11. Coleman D. J., Lizzi F. L., Driller J., Rosado A. L., Chang S., Iwamoto T., Rosenthal D. Therapeutic ultrasound in the treatment of glaucoma. I. Experimental model. Ophthalmology. 1985 Mar;92(3):339–346. doi: 10.1016/s0161-6420(85)34029-0. [DOI] [PubMed] [Google Scholar]
  12. Feibel R. M., Bigger J. F. Rubeosis iridis and neovascular glaucoma. Evaluation of cyclocryotherapy. Am J Ophthalmol. 1972 Nov;74(5):862–867. doi: 10.1016/0002-9394(72)91206-8. [DOI] [PubMed] [Google Scholar]
  13. Fleischman J. A., Swartz M., Dixon J. A. Argon laser endophotocoagulation. An intraoperative trans-pars plana technique. Arch Ophthalmol. 1981 Sep;99(9):1610–1612. doi: 10.1001/archopht.1981.03930020484017. [DOI] [PubMed] [Google Scholar]
  14. Freyler H., Scheimbauer I. Ziliarkörperexzision nach Sautter als ultima ratio bei Sekundärglaukomen. Klin Monbl Augenheilkd. 1981 Dec;179(6):473–477. doi: 10.1055/s-2008-1057367. [DOI] [PubMed] [Google Scholar]
  15. Krupin T., Mitchell K. B., Becker B. Cyclocryotherapy in neovascular glaucoma. Am J Ophthalmol. 1978 Jul;86(1):24–26. doi: 10.1016/0002-9394(78)90008-9. [DOI] [PubMed] [Google Scholar]
  16. Landers M. B., 3rd, Trese M. T., Stefansson E., Bessler M. Argon laser intraocular photocoagulation. Ophthalmology. 1982 Jul;89(7):785–788. doi: 10.1016/s0161-6420(82)34723-5. [DOI] [PubMed] [Google Scholar]
  17. Lee P. F. Argon laser photocoagulation of the ciliary processes in cases of aphakic glaucoma. Arch Ophthalmol. 1979 Nov;97(11):2135–2138. doi: 10.1001/archopht.1979.01020020453008. [DOI] [PubMed] [Google Scholar]
  18. Lee P. F., Pomerantzeff O. Transpupillary cyclophotocoagulation of rabbit eyes. An experimental approach to glaucoma surgery. Am J Ophthalmol. 1971 Apr;71(4):911–920. doi: 10.1016/0002-9394(71)90266-2. [DOI] [PubMed] [Google Scholar]
  19. Merritt J. C. Transpupillary photocoagulation of the ciliary processes. Ann Ophthalmol. 1976 Mar;8(3):325–328. [PubMed] [Google Scholar]
  20. Norris J. L., Cleasby G. W. An endoscope for ophthalmology. Am J Ophthalmol. 1978 Mar;85(3):420–422. doi: 10.1016/s0002-9394(14)77741-4. [DOI] [PubMed] [Google Scholar]
  21. Norris J. L., Cleasby G. W., Nakanishi A. S., Martin L. J. Intraocular endoscopic surgery. Am J Ophthalmol. 1981 May;91(5):603–606. doi: 10.1016/0002-9394(81)90058-1. [DOI] [PubMed] [Google Scholar]
  22. Norris J. L., Stewart W. B. Bimanual endoscopic orbital biopsy. An emerging technique. Ophthalmology. 1985 Jan;92(1):34–38. doi: 10.1016/s0161-6420(85)34069-1. [DOI] [PubMed] [Google Scholar]
  23. PURNELL E. W., SOKOLLU A., TORCHIA R., TANER N. FOCAL CHORIORETINITIS PRODUCED BY ULTRASOUND. Invest Ophthalmol. 1964 Dec;3:657–664. [PubMed] [Google Scholar]
  24. Peyman G. A., Conway M. D., Raichand M., Lin J. Histopathologic studies on transscleral argon-krypton photocoagulation with an exolaser probe. Ophthalmic Surg. 1984 Jun;15(6):496–501. [PubMed] [Google Scholar]
  25. Peyman G. A., Salzano T. C., Green J. L., Jr Argon endolaser. Arch Ophthalmol. 1981 Nov;99(11):2037–2038. doi: 10.1001/archopht.1981.03930020913020. [DOI] [PubMed] [Google Scholar]
  26. Smith R. S., Stein M. N. Ocular hazards of transscleral laser radiation. II. Intraocular injury produced by ruby and neodymium lasers. Am J Ophthalmol. 1969 Jan;67(1):100–110. doi: 10.1016/0002-9394(69)90014-2. [DOI] [PubMed] [Google Scholar]
  27. Vogt A. CYCLODIATHERMYPUNCTURE IN CASES OF GLAUCOMA. Br J Ophthalmol. 1940 Jun;24(6):288–297. doi: 10.1136/bjo.24.6.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Vucicevic Z. M., Tsou K. C., Nazarian I. H., Scheie H. G., Burns W. P. A cytochemical approach to the laser coagulation of the ciliary body. Bibl Ophthalmol. 1969;79:467–478. [PubMed] [Google Scholar]
  29. WEEKERS R., LAVERGNE G., WATILLON M., GILSON M., LEGROS A. M. Effects of photocoagulation of ciliary body upon ocular tension. Am J Ophthalmol. 1961 Aug;52:156–163. doi: 10.1016/0002-9394(61)91110-2. [DOI] [PubMed] [Google Scholar]
  30. Walton D. S., Grant W. M. Penetrating cyclodiathermy for filtration. Arch Ophthalmol. 1970 Jan;83(1):47–48. doi: 10.1001/archopht.1970.00990030049008. [DOI] [PubMed] [Google Scholar]
  31. Wilensky J. T., Welch D., Mirolovich M. Transscleral cyclocoagulation using a neodymium:YAG laser. Ophthalmic Surg. 1985 Feb;16(2):95–98. [PubMed] [Google Scholar]

Articles from Transactions of the American Ophthalmological Society are provided here courtesy of American Ophthalmological Society

RESOURCES