Cyclodestruction

Last updated

Cyclodestruction or cycloablation is a surgical procedure done in management of glaucoma. Cyclodestruction reduce intraocular pressure (IOP) of the eye by decreasing production of aqueous humor by the destruction of ciliary body. Until the development of safer and less destructive techniques like micropulse diode cyclophotocoagulation and endocyclophotocoagulation, cyclodestructive surgeries were mainly done in refractory glaucoma, or advanced glaucomatous eyes with poor visual prognosis. [1]

Contents

Types

Cyclodestruction may be done by using diathermy, penetrating cyclodiathermy, cryotherapy, ultrasound, laser or by surgical excision. [2]

Cyclophotocoagulation

Cyclophotocoagulation (CPC), the most common cyclodestructive procedure is done using laser beam of different wavelengths. Ruby laser (693 nm wavelength), Nd:YAG laser (1064 nm wavelength) or diode laser (810 nm wavelength) can be used to perform CPC. [2] Commomon cyclophotocoagulation techniques include transscleral cyclophotocoagulation (TS-CPC), continuous-wave diode cyclophotocoagulation (CW-TSCPC), MicroPulse diode cyclophotocoagulation (MP-TSCPC), endocyclophotocoagulation (ECP) and high-intensity focused ultrasound cyclodestruction (HIFU). Complications are lesser with Trans-scleral diode laser cyclophotocoagulation and Endoscopic diode laser cyclophotocoagulation. [3] [4] [5]

Transscleral cyclophotocoagulation

Diode laser with a wavelength of 810 nm is used to perform trans-scleral cyclophotocoagulation. [2] In TS-CPC, the laser absorbed by melanin of ciliary processes causes photocoagulation. [6] Since it is a painful procedure, TS-CPC is usually performed under retrobulbar or peribulbar anesthesia. [2] Micropulse transscleral diode cyclophotocoagulation (MP-TSCPC), a modified TS-CPC procedure is a more safer procedure. [7]

Endocyclophotocoagulation

Endocyclophotocoagulation (ECP) or endoscopic cyclophotocoagulation using an endoscope allows direct view of the ciliary processes during surgery. [8] Compared to TS-CPC, tissue disruption is lesser with ECP. [8]

Cyclocryotherapy

Cyclocryotherapy is done by freezing the ciliary processes of the eye. [4] In neovascular glaucoma, cyclocryotherapy is advices when medical control of IOP is not possible. [9]

Complications

Inflammation, retinal detachment, hypotony, phthisis bulbi and sympathetic ophthalmia are some common complications of cyclodestructive procedures. [4] Since there is risk of inflammation which lead to hypotony and phthisis bulbi, cyclophotocoagulation must be done with extreme caution in uveitic glaucoma. [10] Pain, hyphema and iridocyclitis are possible complications of TS-CPC. [2] Fibrin exudates, hyphema, cystoid macular edema and loss of vision are possible complications of ECP.

History

The first surgical procedures to reduce intraocular pressure of the eye, by decreasing production of aqueous humor, by damaging the ciliary body by diathermy, penetrating cyclodiathermy or surgical excision was done in the early twentieth century. [1] Cyclodestruction by diathermy was first performed by Weve in 1933. [11] In 1949, Berens et al. described cyclo-electrolysis. [11] Cyclocryotherapy was first described by Bietti in 1950. [12] Cyclodestruction by cyclophotocoagulation was first performed by Beckman et al., in 1972, using a ruby laser. [13] ECP was developed by Martin Uram in 1992. [14]

Related Research Articles

<span class="mw-page-title-main">Glaucoma</span> Group of eye diseases

Glaucoma is a group of eye diseases that lead to damage of the optic nerve, which transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. A major risk factor for glaucoma is increased pressure within the eye, known as intraocular pressure (IOP). It is associated with old age, a family history of glaucoma, and certain medical conditions or medications. The word glaucoma comes from the Ancient Greek word γλαυκóς, meaning 'gleaming, blue-green, gray'.

<span class="mw-page-title-main">Vitrectomy</span> Surgery to remove vitreous humor from the eye

Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye.

<span class="mw-page-title-main">Farsightedness</span> Eye condition in which light is focused behind instead of on the retina

Far-sightedness, also known as long-sightedness, hypermetropia, and hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blur is due to incoming light being focused behind, instead of on, the retina due to insufficient accommodation by the lens. Minor hypermetropia in young patients is usually corrected by their accommodation, without any defects in vision. But, due to this accommodative effort for distant vision, people may complain of eye strain during prolonged reading. If the hypermetropia is high, there will be defective vision for both distance and near. People may also experience accommodative dysfunction, binocular dysfunction, amblyopia, and strabismus. Newborns are almost invariably hypermetropic, but it gradually decreases as the newborn gets older.

<span class="mw-page-title-main">Nd:YAG laser</span> Crystal used as a lasing medium for solid-state lasers

Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12) is a crystal that is used as a lasing medium for solid-state lasers. The dopant, triply ionized neodymium, Nd(III), typically replaces a small fraction (1%) of the yttrium ions in the host crystal structure of the yttrium aluminum garnet (YAG), since the two ions are of similar size. It is the neodymium ion which provides the lasing activity in the crystal, in the same fashion as red chromium ion in ruby lasers.

A microkeratome is a precision surgical instrument with an oscillating blade designed for creating the corneal flap in LASIK or ALK surgery. The normal human cornea varies from around 500 to 600 μm in thickness; and in the LASIK procedure, the microkeratome creates an 83 to 200 μm thick flap. The microkeratome uses an oscillating blade system, which has a blade that oscillates horizontally as the blade travels vertically for a precise cut. This piece of equipment is used all around the world to cut the cornea flap. The microkeratome is also used in Descemet's stripping automated endothelial keratoplasty (DSAEK), where it is used to slice a thin layer from the back of the donor cornea, which is then transplanted into the posterior cornea of the recipient. It was invented by Jose Barraquer and Cesar Carlos Carriazo in the 1950s in Colombia.

<span class="mw-page-title-main">Eye surgery</span> Surgery performed on the eye or its adnexa

Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

<span class="mw-page-title-main">Cataract surgery</span> Removal of opacified lens from the eye

Cataract surgery, which is also called lens replacement surgery, is the removal of the natural lens of the human eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artificial intraocular lens (IOL).

A glaucoma valve is a medical shunt used in the treatment of glaucoma to reduce the eye's intraocular pressure (IOP).

<span class="mw-page-title-main">Trabeculectomy</span> Surgical procedure used in the treatment of glaucoma

Trabeculectomy is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by removing part of the eye's trabecular meshwork and adjacent structures. It is the most common glaucoma surgery performed and allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is absorbed. This outpatient procedure was most commonly performed under monitored anesthesia care using a retrobulbar block or peribulbar block or a combination of topical and subtenon anesthesia. Due to the higher risks associated with bulbar blocks, topical analgesia with mild sedation is becoming more common. Rarely general anesthesia will be used, in patients with an inability to cooperate during surgery.

<span class="mw-page-title-main">Iridodialysis</span> Medical condition

Iridodialysis is a localized separation or tearing away of the iris from its attachment to the ciliary body.

<span class="mw-page-title-main">Glaucoma surgery</span> Type of eye surgery

Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, and variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous humor.

<span class="mw-page-title-main">Intraocular hemorrhage</span> Medical condition

Intraocular hemorrhage is bleeding inside the eye. Bleeding can occur from any structure of the eye where there is vasculature or blood flow, including the anterior chamber, vitreous cavity, retina, choroid, suprachoroidal space, or optic disc.

<span class="mw-page-title-main">Laser coagulation</span> Procedure widely used in eye surgery

Laser coagulation or laser photocoagulation surgery is used to treat a number of eye diseases and has become widely used in recent decades. During the procedure, a laser is used to finely cauterize ocular blood vessels to attempt to bring about various therapeutic benefits.

Micro-invasive glaucoma surgery (MIGS) is the latest advance in surgical treatment for glaucoma, which aims to reduce intraocular pressure by either increasing outflow of aqueous humor or reducing its production. MIGS comprises a group of surgical procedures which share common features. MIGS procedures involve a minimally invasive approach, often with small cuts or micro-incisions through the cornea that causes the least amount of trauma to surrounding scleral and conjunctival tissues. The techniques minimize tissue scarring, allowing for the possibility of traditional glaucoma procedures such as trabeculectomy or glaucoma valve implantation to be performed in the future if needed.

Sickle cell retinopathy can be defined as retinal changes due to blood vessel damage in the eye of a person with a background of sickle cell disease. It can likely progress to loss of vision in late stages due to vitreous hemorrhage or retinal detachment. Sickle cell disease is a structural red blood cell disorder leading to consequences in multiple systems. It is characterized by chronic red blood cell destruction, vascular injury, and tissue ischemia causing damage to the brain, eyes, heart, lungs, kidneys, spleen, and musculoskeletal system.

<span class="mw-page-title-main">Secondary glaucoma</span>

Secondary glaucoma is a collection of progressive optic nerve disorders associated with a rise in intraocular pressure (IOP) which results in the loss of vision. In clinical settings, it is defined as the occurrence of IOP above 21 mmHg requiring the prescription of IOP-managing drugs. It can be broadly divided into two subtypes: secondary open-angle glaucoma and secondary angle-closure glaucoma, depending on the closure of the angle between the cornea and the iris. Principal causes of secondary glaucoma include optic nerve trauma or damage, eye disease, surgery, neovascularization, tumours and use of steroid and sulfa drugs. Risk factors for secondary glaucoma include uveitis, cataract surgery and also intraocular tumours. Common treatments are designed according to the type and the underlying causative condition, in addition to the consequent rise in IOP. These include drug therapy, the use of miotics, surgery or laser therapy.

Uveitis–glaucoma–hyphaema (UGH) syndrome, also known as Ellingson syndrome, is a complication of cataract surgery, caused by intraocular lens subluxation or dislocation. The chafing of mispositioned intraocular lens over iris, ciliary body or iridocorneal angle cause elevated intraocular pressure (IOP) anterior uveitis and hyphema. It is most commonly caused by anterior chamber IOLs and sulcus IOLs but, the condition can be seen with any type of IOL, including posterior chamber lenses and cosmetic iris implants.

Ocular hypotony, or ocular hypotension, or shortly hypotony, is the medical condition in which intraocular pressure (IOP) of the eye is very low.

Hypotony maculopathy is maculopathy due to very low intraocular pressure known as ocular hypotony. Maculopathy occurs either due to increased outflow of aqueous humor through angle of anterior chamber or less commonly, due to decreased aqueous humor secretion by ciliary body.

Clear lens extraction (CLE), also known as refractive lensectomy or refractive lens exchange (RLE) is a surgical procedure in which clear lens of the human eye is removed. Unlike cataract surgery, where cloudy lens is removed to treat cataract, clear lens extraction is done to surgically correct refractive errors such as high myopia. It can also be done in hyperopic or presbyopic patients who wish to have a multifocal IOL implanted to avoid wearing glasses. It is also used as a treatment for diseases such as angle closure glaucoma.

References

  1. 1 2 Dastiridou, Anna I.; Katsanos, Andreas; Denis, Philippe; Francis, Brian A.; Mikropoulos, Dimitrios G.; Teus, Miguel A.; Konstas, Anastasios-Georgios (2018). "Cyclodestructive Procedures in Glaucoma: A Review of Current and Emerging Options". Advances in Therapy. 35 (12): 2103–2127. doi:10.1007/s12325-018-0837-3. ISSN   0741-238X. PMC   6267695 . PMID   30448885.
  2. 1 2 3 4 5 "Cyclodestructive Procedures in Treatment of Glaucoma - EyeWiki". eyewiki.aao.org.
  3. ↑ Bloom, P. A.; Tsai, J. C.; Sharma, K.; Miller, M. H.; Rice, N. S.; Hitchings, R. A.; Khaw, P. T. (September 1997). ""Cyclodiode". Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma". Ophthalmology. 104 (9): 1508–1519, discussion 1519–1520. doi:10.1016/s0161-6420(97)30109-2. ISSN   0161-6420. PMID   9307649.
  4. 1 2 3 "Glaucoma: Cyclodestruction". American Academy of Ophthalmology. 8 November 2015.
  5. ↑ Ataullah, S; Biswas, S; Artes, P H; O'Donoghue, E; Ridgway, A E A; Spencer, A F (January 2002). "Long term results of diode laser cycloablation in complex glaucoma using the Zeiss Visulas II system". The British Journal of Ophthalmology. 86 (1): 39–42. doi:10.1136/bjo.86.1.39. ISSN   0007-1161. PMC   1770983 . PMID   11801501.
  6. ↑ Tan, Nicholas Y. Q.; Ang, Marcus; Chan, Anita S. Y.; Barathi, Veluchamy A.; Tham, Clement C.; Barton, Keith; Sng, Chelvin C. A. (10 December 2019). "Transscleral cyclophotocoagulation and its histological effects on the conjunctiva". Scientific Reports. 9 (1): 18703. Bibcode:2019NatSR...918703T. doi: 10.1038/s41598-019-55102-0 . ISSN   2045-2322. PMC   6904490 . PMID   31822709. S2CID   209169390.
  7. ↑ "Micropulse Transscleral Cyclophotocoagulation - EyeWiki". eyewiki.aao.org.
  8. 1 2 Falkenberry, Suzanne M.; Siegfried, Carla J. (2009). "Endocyclophotocoagulation". Middle East African Journal of Ophthalmology. 16 (3): 130–133. doi: 10.4103/0974-9233.56225 . ISSN   0974-9233. PMC   2813596 . PMID   20142978.
  9. ↑ Bowling, Brad (2016). Kanski's clinical ophthalmology : a systematic approach (Eighth ed.). Edinburgh: Elsevier. p. 374. ISBN   978-0-7020-5572-0.
  10. ↑ Ramakrishnan, R. (2013). Diagnosis and Management of Glaucoma. New Delhi: Jaypee Brothers Pvt. Ltd. p. 394. ISBN   978-93-5025-578-0.
  11. 1 2 Themes, U. F. O. (7 March 2021). "Cyclodestruction". Ento Key.
  12. ↑ Sinha, Ajit; Rahman, A. (1 March 1984). "Cyclocryotherapy in absolute glaucoma". Indian Journal of Ophthalmology. 32 (2): 77. ISSN   0301-4738.
  13. ↑ Anand, Nandita; Klug, Emma; Nirappel, Abraham; Solá-Del Valle, David (17 August 2020). "A Review of Cyclodestructive Procedures for the Treatment of Glaucoma". Seminars in Ophthalmology. 35 (5–6): 261–275. doi: 10.1080/08820538.2020.1810711 . ISSN   0882-0538. PMID   32936725. S2CID   221769458.
  14. ↑ "Endoscopic Cyclophotocoagulation (ECP) - EyeWiki". eyewiki.aao.org.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.