Cyclophotocoagulation - A report by the American Academy of Ophthalmology

Objective. This document describes cyclophotocoagulation procedures for gla ucoma and examines the evidence to answer key questions about patient selec tion, and efficacy of transscleral and endoscopic techniques. Methods: A-literature search conducted for the years 1968 to 2000 retrieved 130 citations. The author reviewed 34 of these articles and selected 19 fo r the panel methodologist to review and rate according to the strength of e vidence. A Level I rating is assigned to properly conducted, well-designed, randomized clinical trials; a Level II rating is assigned to well-designed cohort and case-control studies; and a Level III rating is assigned to cas e series and poorly designed prospective and retrospective studies, includi ng case-control studies. Results. The predominant problem with all studies on cyclophotocoagulation is the lack of a uniform definition of success, which makes comparisons dif ficult. One randomized controlled trial (Level I evidence) compared the eff icacy of transscleral cyclophotocoagulation with noncontact Nd:YAG and semi conductor diode laser. It found no significant difference between the two, although a significant, problem was the variability allowed with laser para meters. Most of the literature consists of noncomparative case series that provide evidence that is limited and often not convincing. Conclusion: Cyclophotocoagulation is indicated for patients with refractory glaucoma who have failed trabeculectomy or tube shunt procedures, patients with minimal useful vision and elevated intraocular pressure, and patients who have no visual potential and need pain relief (based on Level III evid ence). It may be useful for patients whose general medical condition preclu des invasive surgery or who refuse more aggressive surgery (i.e., filter or tube). It is also useful in emergent situations, such as the acute onset o f neovascular glaucoma. There is insufficient evidence to definitively comp are the relative efficacy of the cyclophotocoagulation procedures for glauc oma. It is the panel's opinion,, however, that semiconductor diode systems appear to possess the best combination of effectiveness (based on Level III evidence), portability, expense, and ease of use at this time. Ophthalmolo gy 2001; 108:2130-2138 (C) 2001 by the American Academy of Ophthalmology.