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Ophthalmology

Cyclodiode Laser Glaucoma Therapy

Cyclodiode laser has traditionally been used to treat high intraocular pressures and refractory cases of glaucoma not amenable to medical or other surgical options. The cyclodiode laser ablates the ciliary processes, reducing aqueous humor formation and lowering the intraocular pressure. The development and advancement in cyclodiode laser delivery devices have expanded treatment options for varying glaucoma subtypes. This activity reviews the background of cyclodiode laser as a treatment for gla

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Cyclodiode laser has traditionally been used to treat high intraocular pressures and refractory cases of glaucoma not amenable to medical or other surgical options.
  • blind, painful eyes or eyes with poor visual potential are also candidates.
  • Cyclodiode has also been described in cases of acute angle-closure glaucoma unresponsive to conventional medical and laser treatment.
  • Glaucoma represents a spectrum of diseases that culminates in a progressive optic neuropathy characterized by optic disc excavation, loss of the retinal ganglion cells, and eventual visual field loss.
  • Intraocular pressure (IOP) is a significant primary risk factor and is the only modifiable risk factor for which treatment can be directed to slow or halt progression.
  • Similar to incisional glaucoma procedures workups, the surgeon should consider the patient's general health, including the status of the other eye.
  • The patient must be assessed on their anesthetic suitability, whether they are a candidate for local anesthesia under peribulbar/retrobulbar block or whether they require a general anesthetic assessment.
  • If ECP is performed with combined cataract surgery, a complete ocular examination and subsequent biometry measurements for IOL selection are required.
  • This assessment should consider any concurrent ocular inflammation and preoperatively control this as necessary.
  • The continuous-wave TCP diode laser emits laser energy at a wavelength of 810 nm.
  • Unlike the continuous-wave TCP, MP-TCP delivers a series of short, pulsed repetitive bursts of laser energy in on/off phases, in which the 'off-phase' allows time for surrounding tissues to cool, therefore lessening propagation of thermal damage while still lowering IOP.
  • In contrast to TCP, ECP laser is performed under direct visualization of the ciliary processes, resulting in localized shrinkage of the ciliary processes and reduced thermal damage to surrounding tissues.
ECP laser
Intraocular
Adult
200 to 300m W
Renal
Not specified in source
Duration
Not specified in source
  • Cyclodiode laser has traditionally been reserved for patients who have failed previous drainage surgery or suffer from refractory glaucomatous conditions, including neovascular, traumatic, aphakic, silicone-oil induced, inflammatory, and congenital/developmental glaucoma.
  • Cyclodiode laser is also recommended in eyes with significant conjunctival scarring from previous surgery, trauma, or inflammation.
  • Cyclodiode can also be utilized in non-surgical candidates and those who display poor compliance with treatment.
  • Increasingly, cyclodiode is seen as a primary treatment option, even in eyes with good visual potential.
  • MP-TCP should be considered, especially in eyes at higher risk of postoperative complications, due to its more favorable safety profile.
  • ECP is commonly combined with cataract extraction but can equally be used as a primary intraocular procedure.
  • Cyclodiode laser is generally not recommended in phthisical eyes with disorganized internal structures or where other alternative and more effective treatment modalities are available, especially in eyes with good vision or at risk of macular edema.
  • ECP is not recommended in patients with advanced pseudoexfoliation because the material obstructs energy uptake.
  • Uveitic patients or neovascular glaucoma cases must also be considered carefully due to their risk of severe inflammation and hypotony post-operatively.
  • Commonly observed complications following diode laser include transient mild-moderate discomfort, conjunctival hyperemia, conjunctival burns, conjunctival hyperpigmentation, transient pupillary ovalization, and transient anterior chamber inflammation.
  • More serious reported complications include hyphaema, vitreous hemorrhage, loss of visual acuity, cataract formation, lens subluxation, malignant glaucoma, choroidal hemorrhage, scleral perforation, hypotony, phthisis bulbi, and sympathetic ophthalmia.
  • Energy levels in TCP greater than 60J per treatment session are generally found to be at higher risk of developing postoperative hypotony.
  • Sympathetic ophthalmia is an infrequent complication from TCP, and the exact rate of occurrence is estimated to range from 0.03 TO 0.17%.
  • Potential risks from ECP include all of the above for transscleral cyclodiode except for conjunctival surface burns.
  • Given the intraocular nature of this procedure, other risks are present, including damage to the crystalline lens, zonular damage, iris damage, retinal detachment, and endophthalmitis.
  • Postoperatively, topical corticosteroid drops are prescribed 4 to 8 times per day; depending on patient characteristics and clinician discretion, anti-ocular hypertensives are usually continued postoperatively initially and then tapered according to the postoperative IOP response.
  • The nursing staff postoperatively ensures the patient's prescription is available, informs them of the drop regime, educates them on potential symptoms and complications, and arranges further follow-up in the eye clinic.
  • review
    Cyclodiode Laser Glaucoma Therapy. StatPearls [Internet] — Daniel Allbon, Jay J. Meyer — StatPearls Publishing, 2022

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov