The Observation Of Endoscopic Cyclophotocoagulation Combined With Pars Plana Vitrectomy In The Treatment Of Refractory Glaucoma

Objective:To disscuss the efficacy of endoscopic cyclophotocoagulation(ECP) combined with pars plana vitrectomy(PPV) in the treatment of refractory glaucoma.Methods:ECP was performed on twenty eyes of 30 patients with refractory glaucom combined with PPV,and two eyes receiving a second treatment.The range of cyclophotocoagulation was from 90 o to 360 o during operation,the mean range of cyclophotocoagulation was(261.0±76.5)o.The changes of intraocular pressure(IOP),visual acuity and complication were observed in the pre-and post-operation.All patients were followed-up from 12 to 20 months,the mean follow-up were 15.2 months.Results:Compared to preoperation,the IOP of postoperation was significantly(P<0. 01)reduced at week 1,4,12,24 and 48[(46.3±10.3) mm Hg vs(16.3±2.8)mm Hg,(14.5±2.2)mm Hg,(17.7±6.0)mm Hg,(18.4±5.8)mm Hg,and(18.5±4.4)mm Hg].The mean number of IOP-decreased drugs used was significantly(P<0. 01) reduced from 4 to 1 of postoperation.Compared with the postoperation,the visual acuity was significantly(P<0. 01)improved.80% of all 30 eyes with the postoperative IOP less than 21 mm Hg did not receive any drug,and 3.3% with drug treatment.Postoperative hyphema were found in 3 eyes within 1-3 days,and absorbed within 7 days.Fibrous exudates in 15 eyes,all of which appeared at the first day of postoperation and were absorbed with anti-infection treatment. Postoperative hyphema were found in 1 eye in the follow-up of 1 year.No other complications were observed.Conclusion:As a new micro-invasive surgery,especially in the patients with refractory glaucoma. Combined with PPV,it can achieve a good IOP lowering,the visual acuity is maximum preserved.