Mechanism of Intraocular Pressure Decrease after Contact Transscleral Continuous-Wave Nd:YAG Laser Cyclophotocoagulation

Abstract

Twenty-two eyes of 11 cynomolgus monkeys were subjected to contact transscleral cyclophotocoagulation with a continuous-wave Nd:YAG laser. The right eye of each monkey was coagulated at the pars plicata region by the contact probe placed 1.0 mm from the limbus, while the left eye of each monkey was coagulated at the pars plana region by the contact probe placed 3.0 mm from the limbus. Physiological and morphological studies were carried out up to 6 months after the treatment. The postoperative intraocular pressure showed a significant decrease within 1 week, corresponding to the inflammation of the anterior chamber. A gradual increase of the intraocular pressure occurred from the 2nd week on and returned to the preoperative value 8 weeks after pars plicata coagulation. The pars plana coagulation group maintained the intraocular pressure lower than the preoperative value until the end of the observation period. Histopathological examinations were carried out by the use of tracer particle perfusion into the anterior chamber. The pathologic features of pars plicata coagulation were necrosis, followed by atrophy of the ciliary process. The tracer particles accumulated at the anterior portion of the space between the bundles of ciliary muscle. The pathologic features of pars plana coagulation were necrosis followed by extension of proliferative tissue into the vitreous. The surrounding extracellular space of the stroma was enlarged, and the ciliary muscles were separated from the sclera. The tracer particles accumulated at the enlarged extracellular space of the stroma and the opened suprachoroidal space. These results suggest that the decrease of the intraocular pressure after pars plicata cyclocoagulation resulted from the reduction of aqueous secretion, whereas that after pars plana cyclocoagulation resulted from enhancement of the uveoscleral outflow through the enlarged extracellular space from the anterior chamber into the suprachoroidal space.