Cyclophotocoagulation - current applications and practical aspects

ZusammenfassungDie Zyklophotokoagulation (CPC) ist wenig invasiv, schnell durchfuhrbar und eine der beliebtesten Glaukomoperationen in Deutschland. Glaukomatologisch wird sie aber eher als Eingriff 2. oder 3.Wahl gesehen. Nicht zuletzt erscheint das Prinzip der Verringerung der Kammerwasserproduktion bei haufig vorliegendem Abflussproblem unphysiologisch, was zu dem eher schlechten Ruf der Zyklophotokoagulation beitragt. Wie die verschiedenen Modi der CPC in diesem Spannungsfeld eingeordnet werden konnen, soll dieser ubersichtsartikel beleuchten. Abstract Despite the advent of a large variety of minimally invasive glaucoma surgery (MIGS) techniques cyclophotocoagulation (CPC) remains a popular treatment option to lower intraocular pressure (IOP) in glaucoma patients. Guidelines for glaucoma treatment point to the rather unphysiological mode of action and, thus, recommend CPC mainly for refractory glaucoma and/or eyes with limited visual potential. The primary target of CPC is the pigmented secretory ciliary body epithelium resulting in a decreased production of aqueous humor. In addition, an increase of aqueous outflow may contribute to the IOP lowering. CPC is generally considered a low risk intervention. However, macular edema, prolonged intraocular inflammation, vision loss, hypotony, pain or phthisis occur at considerable rates. Over the past decades new promising modes of cyclophotocoagulation have evolved aiming at reducing the risk of adverse effects and improving the efficiency. This article provides an overview of the different currently available cyclophotocoagulation modes: Besides the classic transscleral continuous-wave cyclophotocoagulation it covers endoscopic cyclophotocoagulation, micropulse transscleral laser treatment and transscleral controlled cyclophotocoagulation. Various practical aspects of the treatment in light of the current literature are being discussed.