Zyklophotokoagulation – Vielfalt der Anwendungen

Zusammenfassung

Die Zyklophotokoagulation (CPC) ist wenig invasiv, schnell durchführbar und eine der beliebtesten Glaukomoperationen in Deutschland. Glaukomatologisch wird sie aber eher als Eingriff 2. oder 3. Wahl gesehen. Nicht zuletzt erscheint das Prinzip der Verringerung der Kammerwasserproduktion bei häufig vorliegendem Abflussproblem unphysiologisch, was zu dem eher schlechten Ruf der Zyklophotokoagulation beiträgt. Wie die verschiedenen Modi der CPC in diesem Spannungsfeld eingeordnet werden können, soll dieser Übersichtsartikel beleuchten.

Abstract

Despite the advent of a large variety of minimally invasive glaucoma surgery (MIGS) techniques cyclophotocoagulation (CPC) remains a popular treatment option to lower intraocular pressure (IOP) in glaucoma patients. Guidelines for glaucoma treatment point to the rather unphysiological mode of action and, thus, recommend CPC mainly for refractory glaucoma and/or eyes with limited visual potential. The primary target of CPC is the pigmented secretory ciliary body epithelium resulting in a decreased production of aqueous humor. In addition, an increase of aqueous outflow may contribute to the IOP lowering. CPC is generally considered a low risk intervention. However, macular edema, prolonged intraocular inflammation, vision loss, hypotony, pain or phthisis occur at considerable rates. Over the past decades new promising modes of cyclophotocoagulation have evolved aiming at reducing the risk of adverse effects and improving the efficiency. This article provides an overview of the different currently available cyclophotocoagulation modes: Besides the classic transscleral continuous-wave cyclophotocoagulation it covers endoscopic cyclophotocoagulation, micropulse transscleral laser treatment and transscleral controlled cyclophotocoagulation. Various practical aspects of the treatment in light of the current literature are being discussed.

Kernaussagen

• Die Zyklophotokoagulation (CPC) ist ein wenig invasives Verfahren zur Augeninnendrucksenkung, bei dem durch Koagulation des pigmentierten Ziliarkörperepithels primär eine Reduktion der Kammerwasserproduktion angestrebt wird.

• Weiter posterior lokalisierte Laserherde scheinen außerdem einen filtrationsverbessernden Effekt zu haben.

• Die CPC zeichnet sich durch eine schnelle Verfügbarkeit und rasche Durchführbarkeit aus.

• Das Nebenwirkungspotenzial sollte allerdings nicht unterschätzt werden.

• Typischerweise findet die CPC Anwendung, wenn primär filtrationsverbessernde OPs nicht möglich oder sinnvoll sind oder zur Unterstützung nach Drainageimplantaten.

• Es wird zwischen 3 Modifikationen der klassischen CPC unterschieden:

  • In Kombination mit einem anderen intraokularen Eingriff bietet sich die Endo-CPC an.

  • Die optisch rückgekoppelte PCP (COCO-CPC) soll Nebenwirkungen minimieren, zur Wirksamkeit lassen sich allerdings mangels Studien kaum Aussagen treffen.

  • Die Mikropuls-CPC stellt eine interessante neue Option dar, die sich vermutlich durch ein geringeres Nebenwirkungsprofil als die klassische CPC auszeichnet.

Publikationsverlauf

Artikel online veröffentlicht:
31. Mai 2023

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