Transscleral cyclophotocoagulation in the treatment of glaucoma: patient selection and perspectives

Introduction Cyclodestructive procedures involve destroying part of the ciliary epithelium to reduce production of aqueous humor and lower intraocular pressure (IOP). Due to its complication rate, cycloablation was historically reserved for eyes with refractory glaucoma that have failed previous filtration procedures, have poor vision and IOP control despite maximal medical therapy, and for relief of pain in blind eyes. Areas covered In this review paper, we cover different forms of transscleral cyclophotocoagulation (TCPC), their degrees of success, and their complication rates. Contact diode laser transscleral cyclophotocoagulation is currently a commonly used method. Micropulse diode laser transscleral cyclophotocoagulation is a newer paradigm that has shown promising results. We also review the outcomes of TCPC in eyes with different subtypes of glaucoma and ocular history. As the modalities improve, TCPC may be safer than previously assumed, and the indications for TCPC may be expanded. Expert opinion In general, TCPC is an effective and relatively safe way to treat patients with glaucoma. More comparative studies are required to determine if TCPC should be used at earlier stages of disease.