Cyclophotocoagulation for Glaucoma

Cyclophotocoagulation uses a special laser to target the ciliary body, the part of your eye that makes the clear fluid inside your eye. By carefully treating small areas of this tissue, we reduce how much fluid your eye produces each day. Lower fluid production means lower pressure, which helps prevent vision loss from glaucoma.

The laser energy is delivered through a probe that we place against the outside of your eye. Transscleral CPC is performed from outside the eye without making any incisions, making it less invasive than traditional glaucoma surgery. Endocyclophotocoagulation, or ECP, is different because it works from inside the eye and is usually performed in an operating room, often at the same time as cataract surgery.

We typically consider CPC when eye drops and oral medications have not brought your pressure down to a safe level. It may also be an option if you have already had other glaucoma surgeries that did not provide enough control. For some patients, CPC offers a middle step between medications and more complex surgery.

The type of CPC we recommend depends on your glaucoma severity and treatment history. Traditional continuous-wave transscleral CPC is typically reserved for more refractory glaucoma or for patients who are not good candidates for other surgeries, though it carries a higher risk of inflammation and very low pressure. Micropulse transscleral CPC uses short bursts of energy and is often considered earlier in the treatment pathway, including in eyes with useful vision, because it may have a more favorable safety profile, though it is not risk-free.

• Your pressure remains too high despite maximum medical therapy
• You cannot tolerate or afford long-term glaucoma medications
• Previous surgeries like trabeculectomy have failed or are not suitable
• You have advanced or refractory glaucoma needing additional pressure lowering when other options are limited, though the pressure-lowering effect may take weeks and can be variable

Good candidates for cyclophotocoagulation include patients with moderate to severe glaucoma who need better pressure control. We often recommend it for people with difficult-to-treat forms of glaucoma, including neovascular glaucoma or glaucoma after other eye surgeries. Your overall eye health, vision potential, and ability to follow aftercare instructions all factor into whether CPC is right for you.

Patients with very advanced glaucoma or poor vision in one eye may also benefit from CPC, especially when preserving comfort and preventing pain is the main goal. CPC lowers eye pressure but does not reverse vision loss and is not a cure for glaucoma. We will discuss your specific situation during your consultation to determine if this treatment matches your needs.

• Active uveitis or uncontrolled ocular inflammation may require treatment before CPC
• Very thin sclera or prior scleral buckle surgery may affect technique selection
• Eyes at higher risk of very low pressure, such as those with prior cyclodestruction or certain secondary glaucomas, require careful planning
• Visual potential and safety considerations differ for continuous-wave versus micropulse versus ECP

Several CPC techniques exist, each using a slightly different approach or laser type. Transscleral CPC applies the laser through the white outer wall of your eye and is the most common method. Endocyclophotocoagulation, or ECP, uses a tiny camera and laser probe placed inside the eye during cataract or other surgery.

• Transscleral diode CPC delivers laser energy from outside the eye
• Micropulse CPC uses short bursts of energy to minimize tissue damage
• Endocyclophotocoagulation treats the ciliary body from inside during other surgery

Expect your eye to feel irritated and look red for the first day or two after CPC. Mild to moderate discomfort is normal, and some patients notice their vision is more blurry than usual. Resting with your head elevated and using cold compresses on your closed eyelid can help reduce swelling and soothe discomfort.

Avoid rubbing your eye, even if it feels gritty or itchy. Light sensitivity is common, so wearing sunglasses as needed for comfort, both indoors and outside, may help. Most people can resume light activities at home the day after treatment, but follow your specific instructions closely.

Over-the-counter pain relievers like acetaminophen usually control any aching or soreness you feel after CPC. If we prescribe stronger pain medication, take it exactly as directed and only as long as you need it. Inflammation inside the eye is expected, and we will prescribe steroid eye drops to minimize it.

• Use acetaminophen or prescribed pain medication as needed
• Apply cold compresses for 10 to 15 minutes several times daily
• Use pain relievers as directed; some patients can use NSAIDs if medically appropriate, but follow surgeon-specific guidance, especially if you take anticoagulants or have GI or kidney disease
• Report severe or worsening pain that does not improve with medication

You will likely use several types of eye drops after CPC, including steroids to reduce inflammation and, depending on your procedure type and surgeon preference, possibly antibiotics. We will give you a written schedule showing when and how often to use each drop. Setting phone alarms or keeping a chart can help you stay on track.

Continue any glaucoma drops you were using before unless we tell you to stop them. Some patients can reduce or stop certain medications once their pressure improves, but never change your regimen without checking with us first. Proper drop use is essential for good healing and lasting results.

For the first week after CPC, avoid heavy lifting, intense exercise, and any activity that raises pressure in your head or eyes. Swimming, hot tubs, and saunas are off-limits until we clear you, usually after a few weeks. You can watch television, read, and use your computer or phone in moderation if your vision allows.

• No heavy lifting or straining for at least one week
• Avoid vigorous exercise, bending, or yoga inversions
• Keep water, soap, and shampoo out of your treated eye for at least the first week or as instructed
• Wear protective eyewear if you work in dusty or dirty environments
• Ask before resuming contact lenses, usually several weeks post-treatment

We will see you one day and one week after your CPC to check your pressure and look for signs of inflammation or complications. Some patients require same-day or very early follow-up checks, especially if they have very high baseline pressure, advanced disease, or are at risk for pressure spikes. Additional visits at one month and three months help us assess how well your pressure is controlled. Some patients need more frequent checks if their pressure fluctuates or if we adjust medications.

Pressure changes can continue for weeks to months after CPC, so patience is important. We may taper your steroid drops gradually based on how your eye heals. Regular monitoring lets us catch any issues early and decide if you need further treatment.