A new technique for diode laser cyclophotocoagulation

Destruction of the ciliary body, an option in glaucoma surgical treatment, can be performed using various methods. Laser energy, now the principle source for cyclodestruction, can be delivered in a transpupillar, transvitreal in conjunction with a vitrectomy and transscleral manner. The current technique for endocyclophotocoagulation requires of an endoscopic probe. We describe an accessible and inexpensive alternative. Gonioprism-assisted diode cyclophotocoagulation (GADC) with a peripheral corneal approach is a new surgical technique for pseudophakic and aphakic patients that uses a manual gonioprism, iris hooks, ophthalmic operating microscope, and an 810-nm laser diode probe. GADC is performed under topical and intracameral anesthesia, prior pupil dilation. First, 4 iris hooks are placed to expose the posterior chamber. The ciliary processes are viewed through a Swan-Jacob gonioprism and the diode laser probe is inserted through a peripheral corneal incision. The energy of the laser is set at 250 mW and the duration of the application to each process is variable, from 500 to 800 ms, until shrinkage and whitening occur. We apply this technique in approximately 360 degrees of the ciliary processes. Subconjunctival dexamethasone phosphate is administered at the end of the surgery prior subconjunctival injection of lidocaine. GADC has a relatively quick learning curve, allows direct visualization with less energy delivered to the ciliary processes and obviates the acquisition of a new endoscopic device.