Cyclocryotherapy

Abstract

Cyclocryotherapy employs temperatures as low as −112 °F (−80 °C) to destroy the ciliary body, thereby decreasing aqueous production and intraocular pressure. Secondary to the risk of significant intraocular inflammation, loss of vision, and phthisis, cyclocryotherapy may often be used as a last-line treatment option for uncontrolled or refractory glaucoma.

Indications

Glaucoma, uncontrolled by medical therapy

Essential Steps

• 1. Identification of correct eye

• 2. Retrobulbar ± van Lint block

• 3. Identification of treatment areas radially

• 4. Identification of treatment areas posterior to the limbus

• 5. Timed application of the cyroprobe in a circumferential manner

Complications

• Change/loss of vision

• Intraocular inflammation

• Phthisis

• Hyphema or bleeding from the site

• Pain

• Hypotony

• Cataract formation

Template Operative Dictation

Preoperative diagnosis:

Medically uncontrolled glaucoma (OD/OS)

Procedure:

Cyclocryotherapy (OD/OS)

Postoperative diagnosis:

Same

Indication:

This ____-year-old male/female with a well-known and documented history of glaucoma had been unsuccessfully managed with medically (±surgically) controlled treatment plans. After a detailed review of risks and benefits, the patient elected to undergo the procedure.

Description of the procedure:

The patient was identified in the holding area, and the (right/left) eye was marked with a marking pen. The patient was brought into the OR on an eye stretcher in the supine position. After proper time-out was performed verifying correct patient, procedure, site, positioning, and special equipment prior to starting the case, general anesthesia was induced. A LMA/ETT was placed, and local anesthetic was injected in the standard (retrobulbar/peribulbar/van Lint block) fashion using ____ml of lidocaine and bupivacaine in a 50:50 mix. The (right/left) eye was prepped and draped in the usual sterile fashion. The operating microscope was centered over the (right/left) eye, and an eyelid speculum was placed in the eye.

Three quadrants/270° of the eye were identified as treatment areas for the cyclocryotherapy. The cyclocryotherapy probe was turned on, and the locations for therapy were identified _2_mm posterior to the corneal limbus. The probe was then applied in a circumferential pattern to three out of four quadrants of the (right/left) eye. Special care was taken to apply each treatment exactly _2_mm posterior to the corneal limbus, approximately one probe width apart for each treatment location. Each cyclocryotherapy session was conducted for ___ seconds, which was timed on the probe timer. Careful attention was paid so that no conjunctival or corneal involvement was encountered while applying treatment. After 270° (_#_ applications) of cyclocryotherapy was performed, the (right/left) eye was irrigated with sterile BSS. An (combination of antibiotic/steroid/others) ointment was applied to the (right/left) eye, and the eyelid speculum was removed. A pressure patch was placed over the left eye, and the patient was transferred to the postanesthesia care unit in stable condition.

Additional Resource

https://www.youtube.com/watch?v=D5CRcJO3U9M.