| Objective:Glaucoma is the second leading cause of blindness in the world.It is a group of progressive optic nerve diseases,often manifests structural changes in the optic papilla and visual field defects.Optic nerve damage and visual field defects caused by glaucoma are irreversible.Refractory glaucoma has complicated pathogenesis,difficult clinical treatment,and uncertain treatment effect.The pain,vision loss and even blindness caused by the disease often bring great trouble to patients.In this paper,the clinical effects of ultrasound ciliary body plasty,transscleral ciliary body photocoagulation,and ciliary body cryosurgery in the treatment of refractory glaucoma were compared,and the efficacy and safety were evaluated in order to guide clinical rational use,as well as to provide a variety of options for the treatment of refractory glaucoma.Methods:The clinical data of 106 eyes of 105 cases with refractory glaucoma in our hospital from Jan.2018 to Apr.2020 were collected and analyzed retrospectively.They were randomly divided into three groups.Among them,55 eyes of 54 cases were treated with ultrasound ciliary plasty(UCP)in UCP group,31 cases were treated with transscleral ciliary body photocoagulation in photocoagulation group,and 20 cases were treated with ciliary body cryotherapy in cryotherapy group.The efficacy among three groups were compared.The counting data such as preoperative baseline data and the incidence of complications were compared between groups by χ2 test or Fisher’s exact probability method,and data characteristics were described by rate(%).The measurement data obeying normal distribution were expressed as (?)±s,and the variance analysis of repeated measurement data is used for comparison.The differences between groups of the time points and the interaction effects are compared,and the comparison of time points uses paired test.The measurement data of non-normal distribution are represented by M(P25,P75),and compared by nonparametric test.Results:The mean intraocular pressure at preoperation,1 day,1 week,and 1,3,6 months after operation in UCP group were(45.12±8.26),(28.69±10.08),(22.45±7.33),(20.34±5.03),(19.31±4.67)and(19.55±4.12)mmHg(1 mmHg=0.133 kPa);in photocoagulation group were(44.95±10.60),(27.63±9.05),(23.76±8.92),(20.81±5.02),(19.97±4.90)and(19.77±4.77)mmHg;in cryotherapy group were(45.20±7.44),(22.60±7.30),(21.30±8.03),(22.20±7.05),(22.85±6.39)and(23.15±4.67)mmHg.The IOP at each follow-up time in the three groups was significantly lower than that before operation(P<0.05),but there was no significant difference among the three groups(P>0.05).The postoperative pain grade score of each follow-up time in the three groups was lower than that before operation(P<0.05),and it was significantly different in postoperative pain grade among the three groups(P<0.05).Postoperative complication occurred in 26 eyes(47.27%)in UCP group,22 eyes(70.97%)in photocoagulation group,and 17 eyes(85.00%)in cryotherapy group.The last follow-up,the increasing visual acuity occurred in 4 eyes in the UCP group,while no improvement in the other two groups.Conclusion:1.Ultrasound ciliary plasty,ciliary body photocoagulation,and ciliary body cryosurgery have a good efficacy of lowing intraocular pressure,while there is no significant difference among the three groups.2.The three kinds of surgical method can alleviate eye pain.In the early postoperative period,UCP is significantly better than ciliary body photocoagulation and cryosurgery in relieving eye pain,especially on the first day after surgery,the pain grade score of the UCP group was much lower than the other two groups.3.The postoperative complication rate of UCP is less,the safety is high,and the repeatability is good. |
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