There are two approaches to delivering laser energy. Patients should also understand that more than one transscleral CPC treatment session may be needed to achieve the desired control of glaucoma. For transscleral CPC, surgeons should warn patients about the potential for postoperative pain and some reduction of vision. 13Īs with all surgery, patients should understand the plan, requirements, benefits, risks, and alternatives and give informed consent for the proposed procedure. 10-12 Uram, in the early 1990s, developed a clinical method and commercial system for ECP. ECP offers surgeons direct visualization of the ablation's location and effect on target tissue, allows them to adjust the treatment parameters to optimize the tissue's response, and relatively spares underlying pigmented tissue. As with the transscleral approach, it requires profound local (usually peribulbar) anesthesia or general anesthesia in an OR setting, with the usual associated requirements for the patient's cooperation and medical clearance. In the last group, the goal is to reduce the patient's dependence on medical glaucoma treatment.ĮCP is an invasive procedure. It has also been used for eyes with medically controlled glaucoma undergoing phacoemulsification. Additionally, the procedure has been used for eyes with glaucoma undergoing phacoemulsification as an alternative to combined cataract and glaucoma filtering surgery. Although laser CPC is often performed in an office setting, it requires profound local (usually retrobulbar) anesthesia or general anesthesia in an OR setting the patient must be cooperative and medically fit for this administration.ĮCP is for eyes with refractory glaucoma and some eyes with neovascular glaucoma (NVG). Treatment is less likely to be helpful for eyes with a total occlusion of outflow, because they would need a nearly total stoppage of aqueous inflow for the postoperative IOP to fall to acceptable levels. Eligible eyes are often at risk of imminent visual loss from glaucoma. 8,9 Only rarely does visual acuity improve after surgery. 6 The procedure has also been successful as a primary treatment for glaucoma in challenging situations when other interventions are not possible 7 or in patients with a debilitated general medical condition that precludes invasive surgery.Įyes with serious glaucoma-related challenges and good vision are eligible for treatment, but patients should be warned that, depending upon their preoperative vision and diagnosis, their postoperative vision may be somewhat worse than their pretreatment vision. In addition to the successful treatment of severe end-stage glaucoma, transscleral CPC has achieved clinically relevant success rates in cases of refractory glaucoma after penetrating keratoplasty, 1 uveitic glaucoma, 2 glaucoma after intravitreal silicone oil, 3 refractory pediatric glaucoma, 4,5 and failed tube-shunt procedures. The goal is to bring aqueous humor inflow into a better balance with outflow resistance. The laser treatment can be applied to an intact eye through the anterior sclera with continuous-wave red and diode near-infrared lasers (transscleral cyclophotocoagulation ), or it can be accomplished through the invasive direct application of diode near-infrared continuous-wave laser energy to the ciliary processes (endoscopic cyclophotocoagulation ). Effective laser treatment of the ciliary processes and ciliary body reduces the inflow of aqueous humor and, thus, decreases IOP-similar to the effect of several types of glaucoma medications.
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