Transscleral Cyclophotocoagulation For Neovascular Glaucoma

Objective Neovascular glaucoma(NVG) is the common type of refractory glaucoma. Its therapy is very complicated and difficult. This retrospective paper is to investigate postoperative intraocular pressure(IOP), visual acuity, pain, postoperative complications and other conditions of transscleral cyclophoto-coagulation(TSCPC) and cyclocryotherapy, to assess the short-term efficacy of TSCPC. We can provide theoretical foundation for treating advanced NVG.Methods We collected the patients of NVG 48 cases(50 eyes) from 2001.1 to 2002.7 in Shanxi Medical University Second Hospital and Shanxi Eye Hospital. 50 eyes of 48 patients with NVG were divided at random into two groups: 20 eyes(19 patients) with NVG treated by TSCPC, and 30 eyes(29 patients) with NVG treated by cyclocryotherapy. Their IOP, visual acuity, pain and postoperative complications were observed.Follow-up observations were made for all patients for 6 months. Results There was no significant difference between the two groups in preoperative IOP and visual acuity(P>0.05). There was a significant difference between preoperative and postoperative IOP in the two groups (P<0.05) except at 1 day after cyclocryotherapy; IOP at one day and at one week post-TSCPC were 25.14±6.14mmHg, 19.71±6.43mmHg respectively. In comparison with cyclocrotherapy, there was a significant difference in IOP(P<0.01). There was also no significant difference in postoperative visual acuity between the two groups(P>0.05). The visual acuity was improved or preserved in 69.2%(9/13) in TSCPC group, the incidence of decreased visual acuity was lower than that in cyclocryotherapy group. There was a significant difference between the two groups in the incidence of pain at 1 day and 1 week after the surgery. Pain was milder in TSCPC group compared with the eyes in cyclocryotherapy group( P<0.05). Between the two groups there was a significant difference in the incidence of corneal edema and fibrin in the anterior chamber(P<0.05). No cases of phthisis(hypotony) occurred in TSCPC group. The operating efficiency was 80%(16/20), pain relief rate 95%(19/20) that was not significantly different from the eyes treated by cyclocryotherapy(P>0.05). Conclusion 1.TSCPC was as effective as cyclocryotherapy in decreasing IOP. Restoration of IOP to normal levels in the immediate postoperative period occurred in TSCPC.2.The visual prognosis in TSCPC was better, duration of pain was shorter and its rate of complications was lower than that associated with cyclocryotherapy.3.The incidence of the repeated treatment in TSCPC was high. In short, TSCPC for advanced NVG is an effective and safe therapeutic method, which is one of the treatments of choice in advanced NVG.