Name of the Procedure:

Ciliary Body Destruction; Cryotherapy

Summary

Ciliary body destruction, using cryotherapy, is a medical procedure that involves freezing parts of the ciliary body in the eye to reduce the production of intraocular fluid. This helps to lower intraocular pressure, which is beneficial in treating conditions like glaucoma.

Purpose

The procedure addresses elevated intraocular pressure, typically found in glaucoma patients. The goal is to reduce the pressure within the eye to prevent damage to the optic nerve and preserve vision.

Indications

• Primary or secondary glaucoma unresponsive to conventional treatments.
• Patients with refractory glaucoma.
• Situations where other surgical options might not be viable.

Preparation

• Patients may need to fast for a certain period prior to the procedure.
• Medication adjustments might be necessary, especially for anticoagulants.
• Pre-procedure tests, such as eye pressure measurements and visual field tests, may be required.

Procedure Description

1. The patient is given local or, in some cases, general anesthesia to numb the eye and surrounding area.
2. The eye is cleaned and prepared in a sterile fashion.
3. A cryoprobe is applied to the sclera (white part of the eye) overlying the ciliary body.
4. The probe delivers extreme cold, effectively freezing and destructing portions of the ciliary body to reduce aqueous humor production.
5. The process is repeated around the eye as needed.
6. The eye is then covered with a protective shield and the patient is observed for any immediate complications.

Duration

The procedure typically takes about 20 to 40 minutes.

Setting

Ciliary body destruction with cryotherapy is usually performed in an outpatient surgical center or a specialized hospital unit.

Personnel

• Ophthalmologist or glaucoma specialist
• Anesthesiologist or nurse anesthetist (if general anesthesia is used)
• Surgical nurses or technicians

Risks and Complications

• Post-operative eye pain
• Inflammation or infection
• Risk of vision loss if the retina or other structures are damaged
• Rarely, hypotony (excessively low eye pressure) or phthisis bulbi (shrinkage of the eyeball)

Benefits

• Effective reduction of intraocular pressure
• Potential preservation of remaining vision in severe glaucoma cases
• Avoidance of more invasive surgical procedures

Recovery

• Patients are typically given eye drops to manage inflammation and pain.
• Use of an eye shield may be recommended.
• Follow-up appointments are crucial to monitor intraocular pressure and manage any complications.
• Most patients can resume normal activities within a few days, but strenuous activities should be avoided for at least a week.

Alternatives

• Medications like eye drops or systemic treatments to lower eye pressure.
• Laser treatments such as laser trabeculoplasty.
• Other surgeries like trabeculectomy or drainage implants.
• Each alternative has its pros and cons, often involving different risk profiles and efficacy rates.

Patient Experience

• During the procedure, patients may experience pressure but should not feel pain due to anesthesia.
• Post-procedure, some discomfort or mild pain is expected, which can be managed with medications.
• Vision may be blurry initially, but this usually improves as healing progresses.
• Regular follow-up visits are necessary to ensure the procedure's success and manage any long-term care.