Transscleral Cyclophotocoagulation

Transscleral cyclophotocoagulation is a laser procedure that lowers eye pressure by reducing the production of fluid within the eye. This treatment is typically reserved for patients with glaucoma that has not responded adequately to other treatments.

Understanding the Procedure

The eye's ciliary body continuously produces the fluid (aqueous humour) that maintains eye pressure. In cyclophotocoagulation, laser energy is applied through the white of the eye (sclera) to partially reduce the activity of the ciliary body, thereby decreasing fluid production and lowering pressure.

Two main approaches are used:

Continuous-wave treatment delivers sustained laser energy and has been used for many years.

Micropulse treatment delivers laser energy in very short bursts, which may offer a gentler approach with fewer side effects while still achieving pressure reduction.

Who May Benefit

Cyclophotocoagulation is generally considered when other treatments have been insufficient:

• Refractory glaucoma uncontrolled despite maximum medication and previous surgery

• Eyes with limited vision where controlling pressure and discomfort is the primary goal

• Patients unsuitable for incisional surgery due to other health conditions

• Neovascular glaucoma where abnormal blood vessels complicate other surgical options

• Following failed filtration surgery when additional pressure lowering is needed

The American Academy of Ophthalmology provides detailed clinical information about this procedure and its applications.

The Procedure

Cyclophotocoagulation is typically performed as an outpatient procedure:

• Local anaesthetic is administered around the eye

• A probe is placed against the outer surface of the eye

• Laser applications are delivered around the circumference of the eye

• The procedure takes approximately 20-30 minutes

• You may feel pressure but should not experience significant pain during treatment

What Results Can Be Expected

Cyclophotocoagulation can achieve meaningful pressure reduction in many patients with difficult-to-control glaucoma. However, expectations should be realistic:

• Eye pressure typically reduces by 30-40%

• Multiple treatments may be necessary

• The procedure aims to stabilise the condition rather than restore lost vision

• Results may diminish over time, requiring retreatment

The goal is to prevent further vision loss and, in some cases, to reduce pain associated with very high eye pressure.

Potential Risks

As a treatment for advanced glaucoma, cyclophotocoagulation carries more significant risks than some other laser procedures:

• Pain and inflammation are common after treatment and require medication

• Temporary or prolonged low eye pressure can occur

• Vision reduction may occur, sometimes permanently

• Cataract progression if the natural lens is still present

• Need for retreatment is common

• Rare serious complications include severe vision loss or shrinkage of the eye (phthisis)

Micropulse techniques have shown a more favourable safety profile compared to traditional continuous-wave treatment.

Medical Disclaimer: This information provides general guidance about transscleral cyclophotocoagulation and should not replace professional medical advice. This procedure is typically reserved for advanced or refractory glaucoma and carries meaningful risks that must be weighed against the benefits. Your ophthalmologist will discuss whether this treatment is appropriate for your specific situation and what outcomes you can realistically expect.