Rebecca Liebenthal, Malik Y. Kahook, Robert J. Noecker, Joel S. Schuman

Research output: Chapter in Book/Report/Conference proceedingChapter


Cyclodestructive surgery is a procedure traditionally used as a last resort to lower intraocular pressure in cases of refractory glaucoma. It works by damaging the ciliary body to reduce the production of aqueous humor. Cyclodestructive procedures began in the 1930s and have evolved overtime as a multitude of modalities have been attempted, including penetrating and nonpenetrating diathermy, cyclocryotherapy, and ultrasound. Today, cyclophotocoagulation through transscleral Nd: YAG and diode lasers are utilized, as these modalities were found to induce more effective lowering of intraocular pressure without as many adverse effects. The Nd: YAG laser has been predominantly replaced by the diode lasers due to convenience of the probes. Both lasers can be applied through noncontact slit lamp delivery systems or contact probes. The contact probes are typically preferred due to their portability and ease of use. While these procedures are used clinically for refractory glaucoma, risks associated with transscleral cyclophotocoagulation remain, including hypotony and visual decline. Therefore, the procedures are indicated in patients with refractory glaucoma and painfully high intraocular pressure in those with impaired visual acuity. The indications of cyclodestruction have begun to expand to patients without visual decline and more mild forms of glaucoma as modalities continue to improve. Newer forms of cycloablative procedures include the micropulse laser delivery of the transscleral diode laser, endoscopic cyclophotocoagulation, and the high-intensity focused ultrasound. The micropulse laser may offer decreased destruction of surrounding tissue by allowing the tissue to cool before additional laser is applied. The endoscopic approach allows for visualization of the ciliary body to improve delivery of the laser to pigmented areas, and therefore also with potential for decreased collateral damage to adjacent tissue. The endoscopic approach can also be utilized in conjunction with cataract extraction. These modalities have been shown efficacy in both laboratory and clinical studies; however, additional studies are required with longer follow-up times. The newest method of using high-intensity focused ultrasound also in theory allows for more precision; however, it has not demonstrated the same level of reduction in intraocular pressure as compared to more established methods of cyclodestruction.

Original languageEnglish (US)
Title of host publicationAlbert and Jakobiec's Principles and Practice of Ophthalmology
Subtitle of host publicationFourth Edition
PublisherSpringer International Publishing
Number of pages17
ISBN (Electronic)9783030426347
ISBN (Print)9783030426330
StatePublished - Jan 1 2022


  • Aqueous humor
  • Ciliary body
  • Cycloablation
  • Cyclocryotherapy (CCT)
  • Cyclodestruction
  • Cyclophotocoagulaton (CPC)
  • Diode
  • Endocyclophotocoagulation (ECP)
  • Endoscopic
  • Glaucoma
  • Intraocular pressure (IOP)
  • Laser
  • Micropulse
  • Nd: YAG
  • Transscleral
  • Ultrasound

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Cycloablation'. Together they form a unique fingerprint.

Cite this