What is the role of ciliary body ablation in the treatment of primary open-angle glaucoma (POAG)?

Updated: Mar 16, 2020
  • Author: Kristin Schmid Biggerstaff, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Answer

Postoperative pain and inflammation are common complaints. Loss of 1 or more lines of visual acuity has been reported. Phthisis is a concern after this procedure, although it has not been reported as of yet after the diode laser method of cycloablation.

This procedure is indicated as a last resort for patients who have failed medical management and other surgeries or for those patients who have limited visual potential (often 20/200 or less).

By destroying a portion of the nonpigmented ciliary epithelium, aqueous humor production is limited.

The ciliary body epithelium can be destroyed by cyclocryotherapy, diathermy, ultrasound, transscleral Nd:YAG or diode laser (known as cyclophotocoagulation), or a newer endoscopic laser (EndoOptiks, Inc). [22]

Several of the newer surgical procedures are promising, but many ideas have been tried before and few have stood the test of time. Generally, the less complications, the less effective in lowering IOP. There is the possibility that visual loss can be better prevented, with fewer complications, and treatment can be tailored to the individual patient. If simple, safe procedures become available, surgery could be performed earlier in the disease process and adherence to medications could become less problematic.

The ideal glaucoma procedure would use the healthy portions of the outflow system and bypass the diseased portions; control IOP without infection and other risks of a thin-walled bleb; reduce the risk of hypotony during the perioperative period, with less postoperative care management and complications, as compared with trabeculectomy and setons; and provide adequate IOP control for the life of the patient.

Many innovative glaucoma surgical techniques and devices are on the horizon. Interest in this new frontier is because of the lack of an existing, ideal glaucoma procedure despite decades of research. Many devices are not yet approved by the FDA for use in the United States.


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