Transscleral Nd:YAG Laser Cyclophotocoagulation With a Contact Lens

Endoscopic and Transscleral Cyclophotocoagulation for the Treatment of Refractory Glaucoma

“…The reason for waiting until such an advanced degree of glaucomatous loss before considering TCP is that it has the potential for significant complications and associated vision loss. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] It should be noted that the relatively high rates of vision loss are often partially related to the underlying disease process (eg, neovascualar process) and/or severity of the glaucoma, and not entirely due to the laser surgery.…”

“…The outcome is typically less predictable than in other glaucoma surgeries and there is often a substantial risk for significant vision loss. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] In their study of 116 eyes treated by contact Nd:YAG TCP, Schuman et al 24 had 19 eyes (16%) that progressed to NLP and 17 of 36 eyes (47%) with vision of 20/200 or better that lost 2 or more Snellen lines. In addition, 9 out of 116 eyes (8%) developed hypotony (IOP of 3 mm Hg or less) with 6 of these eyes having a pressure of 0 mm Hg.…”

Endoscopic cyclophotocoagulation

“…The largest series on ECP was reported by our group at UCSF and included 68 eyes from 68 patients with refractory glaucoma of various diagnoses including primary open angle (16), congenital (12), chronic angle closure (11), aphakic/ pseudophakic (10), uveitic (10), pseudoexfoliation/ pigmentary (five), neovascular (two), and traumatic (two) ( Table 1). 32 Fifty two patients were white, 14 were AfricanAmerican, and two were Asian-American.…”

Endoscopic cyclophotocoagulation

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25] Laser cyclophotocoagulation has now become the principal method for "turning down the tap." Beckman and Sugar popularised the use of trans-scleral cyclophotocoagulation (TCP) in the early 1970s.…”

“…In the non-contact approach, a slit lamp is employed to apply laser energy through the conjunctival/scleral surface. [12][13][14][15][16][17][18][19] A contact lens may be used to keep the eyelids open and blanch the conjunctiva. The focus of energy delivery is 1-1.5 mm behind the limbus and is offset from the aiming beam so that maximal therapeutic effect is at the level of the ciliary body.…”