Ciliary Body Destruction: Cyclophotocoagulation, Endoscopic, Without Concomitant Removal of Crystalline Lens

Name of the Procedure:

• Ciliary Body Destruction
• Cyclophotocoagulation (CPC)
• Endoscopic Cyclophotocoagulation (ECP)

Summary

Endoscopic Cyclophotocoagulation (ECP) is a minimally invasive laser treatment used to lower eye pressure in patients with glaucoma. The procedure involves using an endoscopic laser to target and destroy parts of the ciliary body, which is responsible for producing the aqueous humor (the fluid inside the eye).

Purpose

ECP aims to reduce intraocular pressure (IOP) in patients with glaucoma by decreasing the production of aqueous humor. This can prevent further damage to the optic nerve, preserve vision, and improve patient quality of life.

Indications

• Patients with various types of glaucoma whose intraocular pressure cannot be controlled with medication or other conventional surgeries.
• Patients for whom other glaucoma surgeries have failed.
• Patients in whom traditional laser treatments are deemed inappropriate.

Preparation

• Patients may need to undergo a comprehensive eye examination and other diagnostic tests like visual field tests.
• Fasting is typically required for a few hours before the procedure.
• Adjustments to current medications, such as blood thinners, may be instructed by the physician.
• Patients should arrange for someone to drive them home afterward.

Procedure Description

1. The patient is typically given a local anesthetic to numb the eye.
2. A small endoscopic probe is inserted into the eye through a tiny incision.
3. Using the endoscope, the surgeon visualizes the ciliary body.
4. A laser is applied to selectively coagulate and destroy parts of the ciliary body to reduce the production of aqueous humor.
5. The probe and other instruments are carefully removed, and the incision is closed if needed.

Duration

The procedure usually takes between 30 to 60 minutes.

Setting

Endoscopic Cyclophotocoagulation is typically performed in an outpatient clinic or surgical center.

Personnel

• Ophthalmic surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Common risks: temporary eye discomfort, inflammation, increased intraocular pressure.
• Rare risks: infection, persistent hypotony (low eye pressure), loss of vision, or bleeding inside the eye.

Benefits

• Effective reduction of intraocular pressure.
• Relief from glaucoma symptoms.
• Potential to preserve remaining vision and prevent further optic nerve damage.
• Benefits often realized within a few weeks post-procedure.

Recovery

• Post-procedure care includes using prescribed eye drops to control inflammation and prevent infection.
• Patients usually need to avoid strenuous activities and protect the eye from injury.
• Regular follow-up appointments are crucial to monitor eye pressure and healing.
• Recovery time is generally about 1 to 2 weeks.

Alternatives

• Medications (eye drops or oral medications to lower eye pressure)
• Other laser procedures such as Laser Trabeculoplasty
• Surgical options like Trabeculectomy or Glaucoma Drainage Devices
• Pros and cons of alternatives: medications may be less invasive but might not be sufficient, other surgeries may have different risk profiles and recovery times.

Patient Experience

• During the procedure, the patient may feel a mild pressure but should not experience pain due to the anesthetic.
• Post-procedure, mild discomfort or irritation in the eye is common, which can be managed with prescribed medications.
• Clear post-operative instructions help ensure a smooth recovery and minimize discomfort.