All of the operations discussed in the preceding chapters lower the intraocular pressure (IOP) by improving the rate of aqueous outflow. This is clearly preferred from a physiologic standpoint, in that the aqueous humor can continue to be produced in an unaltered state and fulfill its various functions, including nourishment of intraocular tissues.
An alternative approach to reducing intraocular pressure, however, is to reduce the rate of aqueous production by partially eliminating the function of the ciliary processes. These techniques are rarely the first operation of choice, because the results are hard to predict and the complication rate is high due to damage to adjacent ocular structures and the influence of a pronounced inflammatory response. However, the cyclodestructive procedures constitute a valuable adjunct in our surgical armamentarium for cases in which other operations have repeatedly failed or when the surgeon wishes to avoid incisional surgery, such as in eyes with poor visual potential or with a high risk of intraocular complications with standard outflow procedures.
