Cyclodestructive Procedures to Lower Intraocular Pressure - A Review

The only therapy for glaucoma, for which there is sufficient evidence, is the lowering of intraocular pressure. Intraocular pressure reduction can be achieved by an improvement in outflow or a reduction of aqueous humor production. Surgically, a reduction of aqueous humor production can be achieved by cyclodestructive procedures. This article provides a brief summary of the different cyclodestructive procedures. The efficacy of cyclophotocoagulation is well documented. The risk profile has been reduced by changes in the laser protocols. Serious complications described in early studies (e.g., visual loss) rarely occur nowadays. The indication spectrum of cyclophotocoagulation has expanded from end-stage glaucoma to glaucoma with good visual acuity. Even the use of cyclodestructive procedures in pediatric glaucoma has gained acceptance. A promising next generation of micropulsed diode lasers could further reduce the risk profile with the same effectiveness. The non-inferiority of micropulse cyclophotocoagulation versus the established procedures has been proven in early studies. However, studies with long-term follow-up and on side-effects are still lacking. Furthermore, a standardized laser protocol must be established.