ABSTRACT Purpose We conducted a systematic search of literature to understand the various methods of imaging of the ciliary body. Methods PubMed, Science Direct, Cochrane Library and Google Scholar were searched comprehensively and systematically to find studies related to the various modalities of ciliary body imaging. Results The various ciliary body parameters that have been described are Ciliary body thickness, Ciliary body length, ciliary muscle thickness, ciliary process length, ciliary muscle length, ciliary muscle anterior length, trabecular ciliary process distance and Iris ciliary process distance. The various angles which have been measured, which mostly have a significance in Primary angle closure glaucoma (PACG) are Iris ciliary angle, Trabecular ciliary angle, scleral ciliary process angle. Various authors have defined them in various ways with subtle differences. Plateau iris and PACG mechanisms, not forgetting malignant glaucoma are better understood with imaging of the ciliary body using the ultrasound biomicroscopy (UBM). The anterior segment optical coherence tomography (ASOCT) imaging of the ciliary body has been described albeit with its own disadvantages. A few other fields dependant on the importance of ciliary body imaging are intravitreal injections, pars plana vitrectomy, measurements for implantable collamer lens (ICL) and of utmost importance, the differentiating features of ciliary body masses. Conclusion The UBM is still preferred over the ASOCT for imaging of the ciliary body. A lot of lacunae of knowledge still exists and consensus has to be reached on defining all the parameters universally. Future studies will be able to shed more light on the role of the ciliary body in the many ocular disorders mentioned in this review.

Imaging of the Ciliary Body: A Major Review

Glaucoma remains a significant problem in ophthalmology. It is characterised by increased intraocular pressure (IOP), visual field loss, and optic nerve degeneration. Despite some progress achieved in the diagnosis and treatment of the disease, millions still suffer from glaucoma (currently, according to WHO, there are more than 106 million people globally), and many patients are already in the later stages. The accompanying pain syndrome sometimes forces doctors to remove the eye. In this regard, several so-called organ-preserving operations were introduced, the purpose of which is to reduce the production of intraocular fluid (IOF) and, accordingly, eliminate the pain syndrome. Glaucoma treatment includes conservative and surgical interventions. Surgical methods for glaucoma treatment aim to improve the outflow of intraocular fluid (fistulising operations) or reduce its production (cyclodestructive procedures). This paper analyses the evolution of surgical interventions to reduce intraocular fluid production by destroying the aqueous humour-producing ciliary processes. Systematic review searches were performed using Google Scholar, Pubmed, Web of Science, Cyberleninka, and Cochrane Library databases for articles published up to 2020 using keywords related to cyclodestruction (CD), cyclophotocoagulation (CPC), and treatment of refractory glaucoma (RG). Keywords: Glaucoma, cyclodestruction, cyclophotocoagulation, ciliary body, diode laser.

A review of cyclodestructive surgical procedures for the treatment of various types of glaucoma

To introduce a novel protocol to treat refractory acute primary angle closure (APAC): transscleral cyclophotocoagulation (TCP) followed by cataract surgery. Thirteen APAC eyes (13 patients) were enrolled in this prospective case series as study group. All patients underwent emergency TCP (20 pulses of 2000 mW during 2000 ms applied to the inferior quadrant) followed by scheduled cataract surgery. They were compared to 13 age- and gender-matched patients treated with emergency phacotrabeculectomy. We recorded intraocular pressure (IOP), best corrected visual acuity (BCVA), and complications, and several ultrasound biomicroscopy (UBM) parameters before and after TCP. In the study group, IOP decreased from 51.5 ± 7.0 mmHg (mean ± standard deviation) before TCP to 16.4 ± 5.4 mmHg 1 day after TCP (P < 0.001). At 6 months, there was no significant difference in IOP between the study group (14.0 ± 3.4 mmHg) and control group (16.7 ± 4.3 mmHg; P = 0.090); IOP lowering medications were used by 0/13 in the study group and 2/13 patients in the control group (P = 0.48). At 6 months, there was no significant difference in BCVA between the study group and the control group (20/25 (20/200 to 20/25) and 20/30 (20/50 to 20/25), respectively; P = 1.0). The UBM parameters anterior chamber depth (P = 0.016), angle-opening distance at 500 μm (P = 0.011), and maximum ciliary body thickness (P < 0.001) increased significantly while the iris-ciliary process distance decreased significantly (P = 0.020) after TCP. TCP effectively lowers IOP and modifies the anterior chamber morphology in APAC; TCP followed by cataract surgery can be considered an alternative to treat refractory APAC but needs further evaluation. This project was registered in Chinese Clinical Trial Registry (ChiCTR1800017475) at July, 31, 2018 (http://www.chictr.org.cn/edit.aspx?pid=29629&htm=4).

/pdf/transscleral-cyclophotocoagulation-followed-by-cataract-3ao7fo5baw.pdf

Transscleral cyclophotocoagulation followed by cataract surgery: a novel protocol to treat refractory acute primary angle closure.

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Transscleral cyclophotocoagulation followed by cataract surgery: a novel protocol to treat refractory acute primary angle closure.