2020–2021 BCSC Basic and Clinical Science Course™
Chapter 13: Surgical Therapy for Glaucoma
Indications and Contraindications
Historically, cyclodestructive procedures were reserved for patients with poor vision potential, as it was thought that those undergoing these procedures were at high risk of postoperative vision decline. However, experience has shown that patients who had cyclodestructive procedures often have acceptable visual outcomes. The procedure is useful in all types of glaucoma, especially for elderly patients when other glaucoma surgeries are refused or not appropriate because of poor health. It is also useful for patients who cannot stop antiplatelet and/or anticoagulation therapy and thus have a higher risk of suprachoroidal hemorrhage with incisional glaucoma surgery. In addition, cyclodestructive procedures can be used in painful eyes with poor vision potential in an attempt to provide comfort by lowering the IOP. However, there is a small risk of sympathetic ophthalmia with cyclodestructive procedures; thus, eyes without light perception should be treated with caution. The combination of corticosteroid and cycloplegic therapy can be very effective in controlling pain in such eyes.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.