Transscleral technologies using physical factors in the treatment of glaucoma
https://doi.org/10.53432/2078-4104-2026-25-2-87-96
Abstract
This review provides a comprehensive overview of the evolution of transscleral technologies employing physical factors in the treatment of glaucoma. The article addresses the effectiveness, safety, and future prospects of various transscleral approaches, including cyclodiathermy, cryodestruction, xenon coagulation of the ciliary body, ultrasound cyclocoagulation and cyclodestruction, pneumocyclodestruction, electrical pulse stimulation of the ciliary body, YAG laser cyclodestruction, diode laser cyclophotocoagulation of the pars plicata of the ciliary body, transscleral thermotherapy, endoscopic laser cyclophotocoagulation with transscleral access, transscleral selective laser trabeculoplasty, as well as transscleral laser technologies targeting the pars plana of the ciliary body (micropulse cyclophotocoagulation, laser activation of scleral hydraulic permeability).
Keywords
Supporting agencies: This work was carried out within the framework of the state assignment of the Krasnov Research Institute of Eye Diseases in the part pertaining to the review of current approaches to transscleral technologies in glaucoma treatment, and within the framework of the state assignment of the National Research Center Kurchatov Institute in the part pertaining to the analysis of laser-induced effects in ophthalmology.
About the Authors
A. A. Gamidov
Krasnov Research Institute of Eye Diseases
Russian Federation
Russian Federation
Dr. Sci. (Med.), senior researcher
11A Rossolimo St., Moscow, 119021
P. D. Gavrilina
AO Klinika K+31
Russian Federation
Russian Federation
Cand. Sci. (Med.), ophthalmologist
42/4 Lobachevskogo St., Moscow, 119415
Ю. Yu. Yusef
Krasnov Research Institute of Eye Diseases
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Director
11A Rossolimo St., Moscow, 119021
O. I. Baum
National Research Centre Kurchatov Institute
Russian Federation
Russian Federation
Dr. Sci. (Pyth. and Math.), lead researcher, Head of Laboratory
1 Kurchatova Sq., Moscow, 123182
A. D. Temirsultanov
Krasnov Research Institute of Eye Diseases
Russian Federation
Russian Federation
clinical resident
11A Rossolimo St., Moscow, 119021
References
1. Verhoeff F.H. Cyclectomy: a new operation for glaucoma. Arch Ophthalmol 1924; 53:228-229.
2. Vogt A. Cyclodiathermypuncture in cases of glaucoma. Br J Ophthalmol 1940; 24(6):288-297. https://doi.org/10.1136/bjo.24.6.288
3. Troncoso M.U. Diathermic surgery of the ciliary body in glaucoma. Am J Ophthalmol 1946; 29(3):269-290. https://doi.org/10.1016/0002-9394(46)90827-6
4. Bietti G. Surgical intervention on the ciliary body. JAMA 1950; 142(12): 889-897. https://doi.org/10.1001/jama.1950.02910300027006
5. Quigley H.A. Histological and physiological studies of cyclocryotherapy in primate and human eyes. Am J Ophthalmol 1976; 82(5):722-732. https://doi.org/10.1016/0002-9394(76)90009-X
6. Vyunova D.M. Cyclocryotherapy for painful glaucoma. Ophthalmology Journal (USSR) 1972; 2:133-134.
7. Zubasheva S.A. A contemporary view of cyclodestructive procedures for glaucoma. Ophthalmic Surgery 2020; 4:67-72. https://doi.org/10.25276/0235-4160-2019-4-67-72
8. El-Aydi I.S. Cryoviscosurgery of refractory glaucoma. Abstract of Diss. Cand. Med. Sci. Moscow, 2013. 24 p.
9. Weekers R., Lavergne G., Watillon M., Gilson M., Legros A. Effects of photocoagulation of the ciliary body upon ocular tension. Am J Ophthalmol 1961; 52:156-163.
10. Silverman R.H., Vogelsang B., Rondeau M.J., Coleman D.J. Therapeutic ultrasound for the treatment of glaucoma. Am J Ophthalmol 1991; 111(3):327-337. https://doi.org/10.1016/S0002-9394(14)76965-0
11. Denis P., Aptel F., Rouland J.F. Cyclocoagulation of the ciliary bodies by high-intensity focused ultrasound: a 12-month multicenter study. Invest Ophthalmol Vis Sci 2015; 56(2):1089-1096. https://doi.org/10.1167/iovs.14-14973
12. Mastropasqua R., Agnifili L., Fasanella V., Toto L., Brescia L., Di Staso S., Doronzo E., Marchini G. Uveo-scleral outflow pathways after ultrasonic cyclocoagulation in refractory glaucoma: AS-OCT and in vivo confocal study. Br J Ophthalmol 2016; 100:1668-1675. https://doi.org/10.1136/bjophthalmol-2015-308069
13. Dzhafarli T.B. Use of pneumo-cyclodestruction in the treatment of open-angle glaucoma. Clinical Ophthalmology 2003; 2:80.
14. Chentsova O.B., Ryabtseva A.A., Yamshchikova I.V. Electropulse stimulation of the ciliary body in primary glaucoma. Eroshevskie chteniya. Conf. theses 1997; 361-363.
15. Beckman H., Kinoshita A., Rota A., Sugar H. Transscleral ruby laser irradiation of the ciliary body in the treatment of intractable glaucoma. Trans Am Acad Ophthalmol Otolaryngol 1972; 76:423-436.
16. Beckman H., Sugar H.S. Neodymium laser cyclocoagulation. Arch Ophthalmol 1973; 90:27-28. https://doi.org/10.1001/archopht.1973.01000050029006
17. Kammer J. Ciliary body as a therapeutic target. In: Surgical Innovations in Glaucoma 2013; 1:45-59. https://doi.org/10.1007/978-1-4614-8348-9_4
18. Krasnov M.M., Bolshunov A.V., Ilyina T.S. Method for the treatment of glaucoma. Moscow; 1989. Patent 480167.
19. Shields M.B., Shields S.E. Noncontact transscleral Nd:YAG cyclophotocoagulation: long-term follow-up of 500 patients. Trans Am Ophthalmol Soc 1994; 92:271-287.
20. Maus M., Katz L.J. Choroidal detachment, flat anterior chamber and hypotony as complications of neodymium:YAG laser cyclophotocoagulation. Ophthalmology 1990; 97:69-72. https://doi.org/10.1016/S0161-6420(90)32640-4
21. Pratesi R. Diode lasers in photomedicine. IEEE J Quantum Electron 1984; 20:1433-1439.
22. Hennis H.L., Stewart W.C. Semiconductor diode laser transscleral cyclophotocoagulation in glaucoma. Am J Ophthalmol 1992; 113(1):81-85. https://doi.org/10.1016/S0002-9394(14)75758-7
23. Fayzrakhmanov R.R., Kalinin M.E., Pavlovskiy O.A., Chekhonin E.S., Sekhina O.L. Current understanding of neovascular glaucoma (review). Ophthalmology Bulletin 2023; 16(3):99-108. https://doi.org/10.17816/OV490823
24. Youn J., Cox T.A., Herndon L.W., Allingham R.R., Shields M.B. Clinical comparison of transscleral cyclophotocoagulation with neodymium: YAG and semiconductor diode lasers. Am J Ophthalmol 1998; 126:640-647. https://doi.org/10.1016/S0002-9394(98)00228-1
25. Stinson W.G., Sherwood M.B. Cyclodestructive procedures for advanced glaucoma: an update. Recent Adv Ophthalmol 1995; 1:91-103.
26. Delgado M.F., Dickens C.J., Iwach A.G., Novack G.D., Nychka D.S., Wong P.C., Nguyen N. Long-term results of noncontact Nd:YAG cyclophotocoagulation in neovascular glaucoma. Ophthalmology 2003; 110(5):895-899. https://doi.org/10.1016/S0161-6420(02)01923-9
27. Iliev M.E., Gerber S. Long-term outcome of trans-scleral diode laser cyclophotocoagulation in refractory glaucoma. Br J Ophthalmol 2007; 91:1631-1635. https://doi.org/10.1136/bjo.2007.116533
28. Lin S.C., Chen M.J., Lin M.S., Howes E. Vascular effects on ciliary tissue from endoscopic versus transscleral cyclophotocoagulation. Br J Ophthalmol 2006; 90(4):496-500. https://doi.org/10.1136/bjo.2005.081570
29. Agarwal H.C., Gupta V., Sihota R. Contact vs non-contact diode laser cyclophotocoagulation for refractory glaucomas using similar energy settings. Clin Exp Ophthalmol 2004; 32(1):33-38. https://doi.org/10.1111/j.1442-9071.2004.00748.x
30. Gorsler I., Thieme H., Meltendorf C. Cyclophotocoagulation and cyclocryocoagulation as primary surgical procedures for open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2015; 253:2273-2277. https://doi.org/10.1007/s00417-015-3092-3
31. Wilensky J.T., Kammer J. Long-term visual outcome of transscleral laser cyclotherapy in eyes with ambulatory vision. Ophthalmology 2004; 111(7):1389-1392. https://doi.org/10.1016/j.ophtha.2003.10.037
32. Uzunel U.D., Yüce B., Küsbeci T., Ateş H. Transpupillary argon laser cyclophotocoagulation in refractory traumatic glaucoma with aphakia and aniridia. Turk J Ophthalmol 2016; 46:38-40. https://doi.org/10.4274/tjo.03934
33. Kulikov A.N., Skvortsov V.Yu. Features of diode-laser transscleral contact cyclocoagulation regimens in the experiment. Preventive and Clinical Medicine 2011; 3:482-484.
34. Uram M. Ophthalmic laser microendoscope ciliary process ablation in the management of neovascular glaucoma. Ophthalmology 1992; 99(12):1823-1828. https://doi.org/10.1016/S0161-6420(92)31745-7
35. Pantcheva M.B., Kahook M.Y., Schuman J.S., Noecker R.J. Comparison of acute structural and histopathological changes in human autopsy eyes after endoscopic and trans-scleral cyclophotocoagulation. Br J Ophthalmol 2007; 91(2):248-252. https://doi.org/10.1136/bjo.2006.104604
36. Ishida K. Update on results and complications of cyclophotocoagulation. Curr Opin Ophthalmol 2013; 24(2):102-110. https://doi.org/10.1097/ICU.0b013e32835d9530
37. Kumar H., Mansoori T., Warjri G.B., Somarajan B.I., Bandil S., Gupta V. Lasers in glaucoma. Indian J Ophthalmol 2018; 66(11):1539-1553. https://doi.org/10.4103/ijo.IJO_911_18
38. Neely D.E., Plager D.A. Endocyclophotocoagulation for management of difficult pediatric glaucomas. J AAPOS 2001; 5(4):221-229. https://doi.org/10.1067/mpa.2001.115164
39. Geffen N., Ofir S., Belkin A., Segev F., Barkana Y., Messas A.K., Assia E.I., Belkin M. Transscleral selective laser trabeculoplasty without a gonioscopy lens. J Glaucoma 2017; 26(3):201-207. https://doi.org/10.1097/IJG.0000000000000619
40. Agrawal P., Martin K. Ciliary body position variability in glaucoma assessed by scleral transillumination. Eye 2008; 22:1499-1503. https://doi.org/10.1038/eye.2008.42
41. Bill A. The aqueous humour drainage mechanism in the cynomolgus monkey (Macaca irus) with evidence for unconventional routes. Invest Ophthalmol Vis Sci 1965; 4:911-919.
42. Liu G.J., Mizukawa A., Okisaka S. Mechanism of IOP decrease after contact transscleral continuous-wave Nd:YAG cyclophotocoagulation. Ophthalmic Res 1994; 26(2):65-79. https://doi.org/10.1159/000267395
43. Nemoto H., Honjo M., Okamoto M., Sugimoto K., Aihara M. Potential mechanisms of IOP reduction by micropulse TSCPC in rabbit eyes. Invest Ophthalmol Vis Sci 2022; 63(6):3. https://doi.org/10.1167/iovs.63.6.3
44. Maslin J., Chen P., Sinard N.R. Comparison of acute histopathological changes after micropulse vs continuous-wave TSCPC (human cadaver eyes). Poster, 26th AGS Meeting; 2016.
45. Sanchez F.G., Peirano-Bonomi J.C., Grippo T.M. Micropulse transscleral cyclophotocoagulation: a hypothesis for the ideal parameters. Med Hypothesis Discov Innov Ophthalmol 2018; 7(3):94-100.
46. Lin S., Babic K., Masis M. Micropulse transscleral diode laser cyclophotocoagulation: short-term results and anatomical effects. American Glaucoma Society; 2016. Poster Presentation.
47. Zhao M., Pekmezci M., Lee R.K., Han Y. Histologic changes following continuous-wave and micropulse TSCPC: randomized comparative study. American Glaucoma Society; 2019.
48. Johnstone M.A., Song S., Padilla S., Wen K., Xin C., Wen J.C., Martin E., Wang R.K. Microscope Real-time Video, High-resolution OCT & Histopathology to Assess How Transcleral Micropulse Laser Affects the Sclera, Ciliary Body, Muscle, Secretory Epithelium, Suprachoroidal Space & Aqueous Outflow System. The Association for Research in Vision and Ophthalmology. Vancouver. Investigative Ophthalmology & Visual Science 2019; 60:2825.
49. Barac R., Vuzitas M., Balta F. Choroidal thickness increase after micropulse TSCPC. Rom J Ophthalmol 2018; 62:144-148.
50. Aquino M.C., Barton K., Tan A.M.W., Sng C., Li X., Loon S.C., Chew P.T. Micropulse versus continuous-wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Exp Ophthalmol 2015; 43(1):40-46. https://doi.org/10.1111/ceo.12360
51. Egorov V.V., Postupaev A.V., Postupaeva N.V. Effectiveness of micropulse cyclophotocoagulation in refractory glaucoma. Modern Technologies in Ophthalmology 2022; 2:88-94. https://doi.org/10.25276/2312-4911-2022-2-88-94
52. Lee J.H., Shi Y., Amoozgar B. Outcome of micropulse TSCPC in pediatric vs adult glaucoma patients. J Glaucoma 2017; 26:936-939. https://doi.org/10.1097/IJG.0000000000000757
53. Khodzhaev N.S., Sidorova A.V., Eliseeva M.A. Micropulse cyclophotocoagulation in combined treatment of neovascular glaucoma. Glaucoma News 2020; 53(1):71-75. https://doi.org/10.25276/2227-8281-2020-1-71-75 (In Russ.)
54. Subramaniam K., Price M.O., Feng M.T., Price F.W. Micropulse TSCPC in keratoplasty eyes. Cornea 2019; 38(5):542-545. https://doi.org/10.1097/ICO.0000000000001897
55. Ioshin I.E., Tolchinskaya A.I., Maksimov I.V. Comparative analysis of outcomes in refractory glaucoma treated by micropulse transscleral cyclophotocoagulation. Ophthalmology 2022; 19(2):318-324. https://doi.org/10.18008/1816-5095-2022-2-318-324
56. Bolshunov A.V., Sobol E.N., Fedorov A.A., Baum O.I., Omelchenko A.I., Khomchik O.V., Shcherbakov E.M. Enhanced filtration of intraocular fluid by non-destructive laser exposure to the sclera in the projection of the flat part of the ciliary body (experimental study). Annals of Ophthalmology 2013; 129(1):22-26.
57. Bolshunov A.V., Sobol E.N., Fedorov A.A., Vorobeva N.N., Gamidov A.A., Omelchenko A.I., Buzykanova M.A., Gudichkov V.B. Changes in the refraction of the rabbit eye during non-ablative IR laser exposure to the sclera in vivo. Refractive Surgery and Ophthalmology 2002; 2(1):55-58.
58. Gamidov A.A., Yusef Yu.N., Gavrilina P.D., Medvedeva E.P. Current capabilities of laser treatment for anterior segment structures of the eye. Annals of Ophthalmology 2023; 139(3-2):107-112. https://doi.org/10.17116/oftalma2023139032107
59. Yusef Yu.N., Gamidov A.A., Gavrilina P.D. Morphological assessment after laser activation of scleral hydraulic permeability in experimental and clinical practice. Medical Physics 2023; 2:105-106.
60. Gavrilina P.D. Laser activation of scleral hydraulic permeability in advanced primary open-angle glaucoma. Cand. Med. Sci. Dissertation. Moscow, 2024, Krasnov Research Institute of Eye Diseases. 124 p.
Review
For citations:
Gamidov A.A., Gavrilina P.D., Yusef Yu., Baum O.I., Temirsultanov A.D. Transscleral technologies using physical factors in the treatment of glaucoma. National Journal glaucoma. 2026;25(2):87-96. (In Russ.) https://doi.org/10.53432/2078-4104-2026-25-2-87-96
Views:
90
JATS XML
Email this article 