Funk J.

Universitäts-Augenklinik Freiburg, Killianstr. 5, D-79106 Freiburg

Both the transscleral and the endoscopic coagulation of the ciliary body are cyclodestructive procedures aiming at a decrease in aqueous humor production. In contrast to the transscleral cyclophotocoagulation, however, the endoscopic approach allows a direkt visualization of the coagulation procedure. We use a commercially available endoscope (Endognost®, Fa. Schwind) together with a 810 nm diode laser (Fa. Iris-Medical) and a special laser fibre. Both the laser fibre and the endoscope are housed in a small tip. Its diameter is about 1 mm. Endoscopic cyclophotocoagulation usually encompasses 180o to 270o of the ciliary body circumference and is performed through a pars-plana or a limbal incision. Whitening and shrinkage of the ciliary processes indicate the correct power setting of the laser. There are three major advantages of the endoscope guided approach: i) Laser burns outside the area of the ciliary processes can be avoided. Those misplaced burns frequently occur after transscleral cyclophotocoagulation ii) The laser energy can be titrated so that over- or underdosage is minimized. Iii) Since the laser beam does not pass the sclera, no side effects in the limbal region can occur. The main disadvantage of endoscopic cyclophotocoagulation is that it is an invasive technique. According to our own experience an anterior vitrectomy is required in most cases to avoid vitreal adhesions to the laser tip. So all the complications of a pars plana vitrectomy have to be expected. Up to now endoscopic cyclophotocoagulation is only recommended in "worst cases", i. e. after failure of one or more conventional operations. But even in these cases high success rates and few serious complications are reported.

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