| Objective To compare the clinical efficacy and safety between ultrasound cyclo-plasty(UCP)and cyclocryotherapy in the treatment of neovascular glaucoma.Furthermore,animal experiments were conducted to further explore the changes in ciliary body tissue after surgery.Methods(1)Prospective cohort study.Patients with neovascular glaucoma who underwent UCP and cyclocryotherapy were enrolled in the First Affiliated Hospital of Anhui Medical University.Among them,26 cases and 26 eyes were included in the UCP group;23cases and 23 eyes were included in the cyclocryotherapy group.The two groups underwent a 6 month clinical study.The follow-up period was 1 day,1 week,1 month,3 months,and 6 months.And the follow-up content included intraocular pressure(IOP)measurement(using noncontact tonometer and goldman tonometer),pain index assessment,anterior segment photography and related complications.The primary outcome was evaluated by the surgical success,which was defined as the IOP reduction of greater than or equal to 20% from the baseline and the IOP value of greater than 5 mm Hg at the last follow-up.The secondary indicators were the mean IOP and pain index at each visit,and all complications during the observation period.Statistical analysis of chi-square test,rank-sum test and Fisher test was performed using SPSS 23.0 statistical software.(2)In the animal experiment,a chronic high IOP model was established for 18 New Zealand rabbits,which were equally divided into the UCP group and the cyclocryotherapy group.The two groups performed monocular surgery in strict accordance with clinical requirements.The changes of ciliary body and the expression of matrix metalloproteinase 1(MMP-1)were observed.Negative controls were performed with contralateral non-operative eyes.Results(1)IOP: The mean baseline IOP of the UCP and the cyclocryotherapy groups was 54.6±9.7 mm Hg and 53.3±11.7 mm Hg,respectively.After six months of follow-up,the UCP group fell to 30.3 ± 9.4 mm Hg,and the surgical success rate was 76%.The cyclocryotherapy group was reduced to 30.4±9.1mm Hg,and the success rate was 77%.There was no statistically significant difference between the two groups(P>0.05).At each follow-up,the effect of reducing IOP of the two operations remained stable and no obvious difference was observed(P>0.05).(2)Pain index: UCP is better than cyclocryotherapy for pain relief.The preoperative pain index was 6.31±1.8 and 6.35±1.7,respectively.The pain index of UCP group dropped to 4.08±1.7 on the night of surgery.The pain index of patients in the cyclocryotherapy group decreased less,at5.52 ± 1.6.After each follow-up,the difference between the two groups was very significant,with statistical significance(P<0.05).(3)Complications: In the cyclocryotherapy group,some patients had decreased visual acuity after surgery,and even lost light perception,but no such patients after UCP.Compared with UCP,the incidence of other complications of cyclocryotherapy is higher and more complex,and serious complications such as retinal detachment and anterior uveitis appear during follow-up after cyclocryotherapy.(4)Animal experiments: The ciliary body histological study of New Zealand rabbits showed that the ciliary process after cyclocryotherapy was atrophied due to hypothermia and was completely destroyed.MMP-1 was only distributed in the ciliary muscle.However,MMP-1 was retained in the ciliary body after UCP.Not only the ciliary muscle was not affected by ultrasound,but also the base of the ciliary process remained normal.And only the double-layer epithelial cells presented coagulative necrosis.ConclusionsThe UCP treatment and cyclocryotherapy both showed good efficacy in significantly reducing the IOP.However,the UCP treatment was safer with less postoperative complications and adverse effects.Thus,the overall treatment effect of the UCP was more efficient than that of cyclocryotherapy.In the non-incision surgery,UCP is expected to become a new choice for the treatment of neovascular glaucoma,creating a new model of precise treatment. |
PDF Full Text Request