Cyclodestructive Procedures

Cyclodestructive procedures are often used in managing refractory childhood glaucoma by targeting and destroying the ciliary body epithelium to lower intraocular pressure (IOP). The most common of these procedures is transscleral cyclophotocoagulation (TS-CPC) which has shown some success in lowering IOP following medical and other surgical interventions. Two separate modalities of TS-CPC have been used: continuous-wave CPC (CW-CPC) and micropulse CPC (MP-CPC). Both techniques are currently in use and have demonstrated efficacy in the short term. However, recent evidence indicates that neither CW-CPC nor MP-CPC maintains low IOP over the long term, often necessitating re-treatments to maintain the IOP lowering effects. In this chapter, we explore various cyclodestructive procedures (CW-CPC, MP-CPC, endoscopic CPC, and cyclocryotherapy), examine their efficacy, and highlight their complications, in an attempt to evaluate their roles for managing childhood glaucoma. Additionally, we will examine their limitations to identify areas for future research and development.