Cyclophotocoagulation
Rather than improving drainage, cyclophotocoagulation lowers eye pressure by gently reducing how much fluid the eye's ciliary body produces in the first place.
What Is Cyclophotocoagulation?
Cyclophotocoagulation uses laser energy to gently treat the ciliary body — the ring of tissue behind the iris responsible for producing the eye's internal fluid (aqueous humor). By reducing how much fluid is produced, eye pressure falls, offering an approach that works independently of, and can be combined with, any drainage-based treatment (drops, laser trabeculoplasty, MIGS, trabeculectomy, or tube shunt).
Endoscopic Cyclophotocoagulation (ECP)
ECP uses a small camera and laser probe inserted into the eye to directly visualize and treat the ciliary body under precise, controlled conditions. Because the treatment is directly visualized rather than applied from outside the eye, it allows for more targeted, controlled energy delivery. ECP is frequently combined with cataract surgery, using the same small incision, and is generally used for mild-to-moderate glaucoma.
Transscleral Cyclophotocoagulation
Transscleral treatment applies laser energy from outside the eye, through the sclera (the white outer wall), to reach the ciliary body without entering the eye directly. The original continuous-wave technique delivers steady energy and has historically been reserved more often for advanced, refractory, or blind painful eyes, given a higher risk of over-treatment effects. A newer micropulse transscleral technique delivers the same laser energy in rapid, brief pulses with rest periods in between, which reduces collateral tissue damage and has meaningfully improved the safety profile — as a result, micropulse transscleral cyclophotocoagulation is now used earlier in the disease course, not just as a last resort.
Indications
- ✓Glaucoma not adequately controlled with drops, laser trabeculoplasty, or MIGS
- ✓Combined with cataract surgery (ECP) for mild-to-moderate glaucoma
- ✓Refractory or advanced glaucoma, including eyes with prior failed surgery (transscleral, particularly continuous-wave)
- ✓Eyes with limited visual potential or where a lower-risk, non-drainage-based option is preferred
Risks & Side Effects
- ✓Inflammation inside the eye following treatment, usually managed with a short course of steroid drops
- ✓Temporary or, less commonly, more prolonged discomfort
- ✓Rarely, an excessive drop in eye pressure (hypotony), more associated with continuous-wave transscleral treatment at higher energy
- ✓Vision changes, more relevant with more extensive continuous-wave treatment in eyes with pre-existing advanced disease
Cyclophotocoagulation is one of several treatment tools that can be layered onto, or combined with, drops, SLT, MIGS, or traditional surgery, depending on how much pressure reduction is still needed and each patient's specific glaucoma severity.
Frequently Asked Questions
How is this different from MIGS or trabeculectomy?
MIGS, trabeculectomy, and tube shunts all work by improving how fluid drains out of the eye. Cyclophotocoagulation works upstream of that, reducing how much fluid the eye produces to begin with — a fundamentally different mechanism.
Is this only for severe or blind, painful eyes?
Not anymore. Older continuous-wave transscleral treatment was historically reserved mainly for advanced or blind, painful eyes due to a higher complication rate. Newer micropulse transscleral technique and endoscopic cyclophotocoagulation (ECP) have a better safety profile and are now used earlier in the disease course as well.
Can ECP be combined with cataract surgery?
Yes. ECP is frequently performed at the same time as cataract surgery, using the same incision, similar to several MIGS devices.
Is this painful?
Transscleral treatments are typically performed with local anesthesia (and sometimes light sedation) given the treatment covers a larger area; ECP is usually done under the same anesthesia as the accompanying cataract or other intraocular surgery.
See a glaucoma specialist. Dr. Robert Gunzenhauser is Harvard-educated and UCLA fellowship-trained in glaucoma, providing expert diagnosis and treatment for Cyclophotocoagulation at Inland Glaucoma Center in Upland, CA.