Ciliary body destruction; cyclophotocoagulation, transscleral
CPT4 code
Name of the Procedure:
Ciliary Body Destruction; Cyclophotocoagulation, Transscleral (Common names: Transscleral Cyclophotocoagulation, TSCPC)
Summary
Transscleral Cyclophotocoagulation (TSCPC) is a laser treatment designed to lower eye pressure by targeting and reducing the activity of the ciliary body, which produces the fluid inside the eye.
Purpose
Transscleral Cyclophotocoagulation is used to treat glaucoma, a condition characterized by increased intraocular pressure (IOP) which can lead to optic nerve damage and vision loss. The goal of the procedure is to lower IOP to prevent or slow the progression of optic nerve damage.
Indications
- Moderate to severe glaucoma that is not adequately controlled by medications or other surgical procedures.
- Patients who are not good candidates for other glaucoma surgeries.
- Patients experiencing refractory glaucoma despite previous surgical interventions.
Preparation
- Patients may be instructed to stop certain medications before the procedure.
- Pre-procedure assessments may include a detailed eye examination and measurements of intraocular pressure.
- Fasting is usually not required, but patients should follow specific instructions provided by their healthcare practitioner.
Procedure Description
- The patient receives local anesthesia to numb the eye.
- The surgeon uses a specially designed laser probe that is applied externally to the sclera (the white part of the eye).
- The laser delivers targeted energy to the ciliary body, which reduces the production of aqueous humor (the fluid inside the eye) to lower intraocular pressure.
- The procedure is often performed with a handheld device that the surgeon expertly maneuvers to apply the necessary laser spots.
Duration
The procedure generally takes approximately 10 to 30 minutes.
Setting
Transscleral Cyclophotocoagulation is typically performed in an outpatient clinic or a specialized surgical center.
Personnel
- Ophthalmologist (specifically a glaucoma specialist).
- Supporting medical staff including nurses and technicians.
Risks and Complications
- Common risks include eye pain, redness, and inflammation.
- Less common but more serious complications may involve prolonged low eye pressure (hypotony), vision loss, and infection.
- In some cases, multiple procedures may be necessary.
Benefits
- Significant reduction in intraocular pressure.
- May prevent further optic nerve damage and preserve vision.
- Non-invasive compared to many traditional surgical methods.
Recovery
- Patients can usually go home the same day.
- Eye drops or medications may be prescribed to manage pain and inflammation.
- Follow-up appointments are necessary to monitor eye pressure and overall eye health.
- Recovery time varies, but most patients resume normal activities within a few days.
Alternatives
- Medications (eye drops, oral medications) to lower intraocular pressure.
- Other surgical interventions such as trabeculectomy, glaucoma drainage devices, or Minimally Invasive Glaucoma Surgery (MIGS).
- Each alternative has its own set of pros and cons regarding effectiveness, risks, and recovery period.
Patient Experience
- The patient will feel minimal to mild discomfort due to local anesthesia.
- Some post-procedure pain or discomfort which can be managed with prescribed pain relief.
- Vision may be temporarily blurry, and there may be redness or swelling in the treated eye.
- Patients will require someone to drive them home post-procedure.