Cyclodestructive Procedures

Over the last decade, laser destruction of the ciliary body has gradually replaced cryode-struction as the cyclodestructive procedure of choice in refractory congenital glaucoma, since the ocular side effects are less severe after laser surgery. Owing to the anomalous limbal anatomy of buphthalmic eyes, it is feasible to perform transscleral laser coagulation of the ciliary body with the aid of transscleral illumination in order to determine the exact localization of the ciliary body and to identify areas of previous destruction.

The most frequent method used to destroy the nonpigmented ciliary body in pediatric glaucoma is contact-diode transscleral cyclo-photocoagulation (TSCPC). Most retrospective studies reveal that this laser procedure is generally applied more than once in each patient. Although IOP reduction can be achieved by TSCPC after îyear, the success rates are not always completely convincing, ranging between 27% and 79% [5, 28,35] depending on the success criteria used and the number of laser interventions. The results following contact-diode transscleral laser cyclophotocoagulation seem to be worse in congenital or juvenile glaucoma compared than in older patients with primary open-angle glaucoma [50]. Possibly, regenerative mechanisms of the infantile ciliary epithelium contribute to this finding.

The postoperative risk of phthisis seems relatively low, around 3.5% [28]. Signs of intraocular inflammation are relatively frequent, around 25 %. Especially in aphakic eyes, severe vision-threatening postoperative complications including retinal and choroidal detachment have been described in children. [5]

Was this article helpful?

0 0

Post a comment