Cyclocryotherapy- for end stage glaucoma

Cyclocryotherapy (CCT) is a procedure that employs temperatures as low as -112°F (-80°C) to destroy the ciliary body (source production of intraocular fluid).

The main purpose of CCT is to treat uncontrolled or refractory glaucoma. It is also used to reduce ocular pain in some patients with end-stage glaucoma.

Demographics

Patients with neovascular glaucoma and congenital glaucoma make up a large percentage of the patients who undergo CCT. Because of the risks involved, cyclocryotherapy should not be performed on patients who have the potential for good vision, or on individuals who have had cataract surgery with intraocular lens implantation.

Description

Cyclocryotherapy is usually performed while the patient is awake and supine (laying down on the back). Prior to doing CCT, the doctor will inject an anesthetic into the posterior part of the eye; however, CCT may be performed under general anesthesia for anxious adults and for children. In performing the procedure, the surgeon locates the ciliary body with a lighted instrument and then applies a cryoprobe with a temperature of -112°F (-80°C) to the sclera of the eye. This probe is applied to the eye several times in a clockwise manner, using moderate pressure, carefully avoiding the area of the eye where the extraocular muscles, which control movement of the eye, attach to the eye. Each application by the probe lasts 50–60 seconds and usually only half of the eye is treated during the initial attempt; for less severe glaucoma and in older patients who respond better to this treatment, only a quarter of the eye will be treated. The surgeon leaves at least one quadrant of the eye untreated.

Immediately after surgery, a steroid is injected into the eye to reduce inflammation, and an eyedrop or ointment such as atropine is applied to the eye to maintain dilation of the eye. Some surgeons may inject into the eye an anesthetic that numbs the entire eye, including the muscles. This injection has many risks associated with it, such as a droopy eyelid and an increased risk of corneal ulcers.

most common SE is pain, others is hypotony and may lead to phithisis bulbi (fluid level in eye reach dangerously low level that compromise integrity of eyeball). Other risks:

-corneal edema

-inflammation of iris

-cataract

-macula edema

-retinal detachment

loss of visual acuity including total loss of vision occur in up to 67% patient.

diabetic pt render higher risk.

source:http://www.surgeryencyclopedia.com/Ce-Fi/Cyclocryotherapy.html