| Objective:To evaluate the clinical effect of the cyclophotocoag ulation through 23 G minimally invasive corneal or scleral incision i n the treatment of refractory glaucoma.Methods:Totally 56 patients(56 eyes)with refractory glaucoma were randomly divided into two groups(cyclophotocoagulation gro up and Ahmed group)from December 2014 to March 2016.28 pati ents(28 eyes)in cyclophotocoagulation group were undergoing cycl ophotocoagulation through 23 G corneal or scleral incision,while 28 patients(28 eyes)in Ahmed group were undergoing Ahmed glauco ma valve implantation.Patient's intraocular pressure(IOP),the quanti ty of drugs reducing intraocular pressure,the best corrected visual a cuity(BCVA),and complications were recorded 1 day,1 weeken d,and 1,3,6 and 12 months after two treatments.And they wer e compared with the preoperation,s.Results:The BCVA of two groups in the pre-and post-oper ation had no statistically significant difference(P>0.05).Measurement of the mean IOP in the Photocoagulation group showed the following results: at the preoperation it was 42.2±11.0 mmHg,on the day 1 it was 17.4±4.8 mmHg,on the day 7 it was 15.8±4.9 mmHg,after 1 month it was 15.1±5.5 mmHg,after 3 mo nths it was 16.7±5.6 mmHg,after 6 months it was 18.0±5.5 m mHg,and after 12 months it was 16.5±6.9 mmHg.Measurement of the mean IOP in the Ahmed group showed the following result s: at the preoperation it was 40.6±12.8 mm Hg,on the day 1 it was 14.2±4.5 mmHg,on the day 7 it was 15.8±5.4 mmHg,af ter 1 month it was 13.9±3.5 mmHg,after 3 months it was 19.4±4.1 mmHg,after 6 months it was 19.4±5.8 mmHg,and after 12 months it was 18.0±6.2 mmHg.There was statistically signific ant difference(P<0.05)between the pre-and postoperative IOP i n the each groups.There was no statistically significant difference(P>0.05)between the two groups in the preoperative IOP.There were no statistically significant difference(P>0.05)between the t wo groups in the postoperative IOP at 1day,7days,1 month and 3months.There were statistically significant difference(P<0.05)b etween the two groups in the postoperative IOP at 6 months and 1year: the IOP of cyclophotocoagulation group were less obviously t han group Ahmed.In cyclophotocoagulation group,the species nu mber of IOP-decreased drugs was 3.4±0.5 at the preoperation while it was 0.6±0.7 at the postoperation.There was statistically si gnificant difference(P<0.05)between the pre-and post-operation in the cyclophotocoagulation group.In Ahmed group,the species number of IOP-decreased drugs was 3.8±0.6 at the preoperation while it was 1.0±0.1 at the postoperation.There was statisticall y significant difference(P<0.05)between the pre-and post-oper ation the Ahmed group.There was no statistically significant differe nce(P>0.05)between the two groups at the preoperation.Ther e was statistically significant difference(P>0.05)between the t wo groups at the postoperation.The complications in the cyclophot ocoagulation group are lighter,few and restored by positive treatme nts.Ahmed group complications are various,and some complications,such as exposure of the drainage tube,corneal endothelial dysfun ction,and drainage plate fibrosis package,seriously affectting the su rgical curative effect.Conclusion:1.The cyclophotocoagulation through 23 G minimally invasive c orneal or scleral incision is effective way for the treatment of refra ctory glaucoma.2.The early effcets are equal between cyclophotocoagulation gr oup with Ahmed group;however,the cyclophotocoagulation group i s superior to Ahmed glaucoma valve implantation in the fields of the medium and long term effect.The quantity of drugs reducing i ntraocular pressure and complications in the cyclophotocoagulation gr oup were less than the Ahmed group.3.The cyclophotocoagulation through 23 G minimally invasive c orneal or scleral incision have more advanteges,such as simple,rep eatability,no suture,small trauma,quick healing,fewer complicatio ns,and can be combined in the other eye surgery.4.There is no best parameter relationship between energy,sco pes and IOP.It is still need futher clincal researchs,then the indiv idualized design can be come true. |
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