Laser Cyclophotocoagulation for Glaucoma
Laser cyclophotocoagulation is a laser treatment used to decrease pressure inside the eye (intraocular pressure). Two types of laser technology (transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation) can be used in this procedure, with both working to alter the fluid-forming cells in the ciliary body (a structure located behind the iris) so they produce less aqueous humor.
Who Is a Good Candidate for Laser Cyclophotocoagulation?
Laser cyclophotocoagulation can be performed on open-angle glaucoma or angle-closure glaucoma.
For some, laser cyclophotocoagulation is used to lower eye pressure to a level that prevents further vision loss from glaucoma. For others, the treatment may be used in an eye with low vision and painful glaucoma in order to lower pressure enough to make the eye comfortable.
Your doctor will determine if you are a good candidate for laser cyclophotocoagulation as well as which form of the treatment is the best option for you based on your unique situation.
Before the Procedure
Your doctor will provide you with instructions prior to your procedure. As powerful laser energy is used for this treatment, local anesthesia behind/around the eye is necessary. This means your doctor may recommend that you stop taking blood thinners (especially Coumadin), products containing aspirin, and many arthritis medications usually a week prior to the procedure. Blood tests and other preoperative tests are typically not required.
Your treatment may take place in the laser room at the Dean McGee Eye Institute (DMEI) but more often it is performed at the McGee Eye Surgery Center (MESC). For procedures taking place at the MESC, you should withhold food and drink six hours prior to the laser surgery. Those who have diabetes and/or use insulin will receive special instruction from their doctor prior to surgery.
Once local anesthesia is administered and the eye is numb, the untreated eye will be patched to protect it. A small device, called a lid speculum, will be placed on the treated eye to hold it open. You may feel pressure from the device, but there should be no pain during the procedure.
During a transscleral cyclophotocoagulation treatment, a laser probe is placed on the white wall of the eye, just outside the circle formed by the iris and the cornea, and 15 to 30 laser treatment spots are administered. With endoscopic cyclophotocoagulation, a small scope is placed through a small incision at the edge of the cornea, much like cataract removal. The scope is used to directly visualize the parts of the eye that make aqueous humor and laser energy is directed to this area.
You may hear beeping and feel/hear some popping noises, which are normal and expected. Overall, the procedure is usually completed within 10 to 15 minutes.
Following the Procedure
Medication is placed in the treated eye and a patch is placed over it. When your doctor deems you are stable, you will be discharged to be driven home by a friend or family member.
Are There Risks Associated with Laser Cyclophotocoagulation?
Postoperative pain is typically minimal, but you may feel some discomfort for several days following the laser surgery. Painkillers and anti-inflammatory eye drops may be prescribed if needed.
Depending on your eye’s response to the treatment, eye pressure immediately following the procedure may be high or low. Occasionally, the treatment results in excessive lowering of eye pressure. This can cause decreased vision, which may not be correctable.
Other complications can include inflammation or bleeding inside the eye, swelling in the back of the eye, or, if performed in an eye with its own natural lens, development of a cataract.
You will be instructed to keep the eye patch on for several hours or overnight, at which time the patch can be removed and you may resume normal activities. Your doctor may prescribe eye medications to be used once the patch is removed, and you will most likely have a follow-up appointment at DMEI the day following the procedure.
You may be asked to temporarily continue taking your preoperative glaucoma medications. It can take up to a month for you to achieve optimal results from the treatment. Your doctor may have you decrease or stop taking your glaucoma medications if eye pressure begins to drop to an acceptable level.
Follow-Up Laser Treatments
If your intraocular pressure does not drop to an acceptable level, or if laser cyclophotocoagulation was performed for comfort and the eye remains painful, repeat laser treatments may be necessary.