Cyclodestructive Procedure

What is a cyclodestructive procedure?

A cyclodestructive procedure is used to treat some forms of severe glaucoma. In glaucoma, fluid in the eye builds up and puts pressure on the nerve that connects the eye to the brain. A cyclodestructive procedure reduces the amount of fluid an eye can produce by destroying part of the ciliary body. The ciliary body is an internal part of the eye that makes fluid.

The ciliary body can be treated with freezing or laser. If laser is used, the procedure is sometimes called cyclophotocoagulation.

When is it used?

This procedure is most often done when other treatments have not worked, or would not be safe. Other treatments include pressure-lowering drops, filtering surgery (trabeculectomy), or a glaucoma tube implant. In rare cases, a cyclodestructive procedure is the first treatment for eyes that have severe glaucoma and poor vision due to severe disease in the back of the eye.

How do I prepare for the procedure?

Arrange for someone to take you home when your surgery is over.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.

If you are taking daily aspirin for a medical condition, ask your provider if you need to stop it before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

If you are going to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Do not wear any eye makeup on the day of the procedure. If you are taking prescription eyedrops, keep taking them on the day of the procedure unless told otherwise by your eye healthcare provider.

What happens during the procedure?

If you are having local anesthesia, the provider will numb your eye by injecting an anesthetic through your lower eyelid into the space behind your eye. You may also be given a sedative to relax you. If you have general anesthesia instead, the anesthetic will relax your muscles and put you to sleep. Both types of anesthesia will prevent you from feeling pain during the operation.

Your surgeon will use freezing or a laser on the outside surface of the eye to destroy part of the ciliary body. The procedure will take 5 to 15 minutes once you are asleep and your eye is numb. If you are awake during the procedure, and a laser is used, you may hear a popping sound when the laser is on.

In some cases, laser treatment of the ciliary body is done surgically from the inside of the eye. This is more common if you are having other surgery on that eye at the same time.

What happens after the procedure?

After the procedure the provider will put in some eyedrops or ointment and place a patch on your eye. You will be given a prescription for eyedrops and pain medicine. You will also need to schedule a follow-up appointment. Your vision may be blurry and you may have some pain while your eyes heal.

What are the benefits of this procedure?

The main benefit is the control of eye pressure. In some cases, it also relieves eye pain. Controlling the pressure may reduce the risk of permanent blindness and help you keep your vision.

What are the risks associated with the procedure?

The main risks of cyclodestructive procedures are:

• Inflammation, which is very common in this procedure and can cause some pain and scarring in the eye. Generally, it is easy to control.
• Creation of a cataract, which is a clouding of the lens in the eye, which can cause blurry vision. Often cataracts can be treated with surgery.
• Hypotony, which is an eye pressure that is too low. This is a very difficult problem to overcome and can lead to phthisis, where the eye shrinks in size and you can no longer see.

When should I call my eye healthcare provider?

Call your eye care provider if:

• You have severe or worsening pain.
• You have nausea or vomiting.
• You have a decrease in vision.
• You see haloes around objects.