| Objective:Efficacy and safety of endoscopic cylocryotherapy in the treatment of refractory glaucoma.Methods:This study is a prospective clinical control study,selected from March 2018 to March 2020 refractory glaucoma patients 36 cases(36 eyes)were selected and divided into 2 groups according to the operation mode,including 14 cases in ECC group and 22 cases in ECP group.Patients underwent follow-up examinations on the 1 week,lmonth and 6 month after initial treatment..The examination of anterior segment photography,fundus photography and ultrasound biomicroscope were applicated preoperatively.The BCVA,intraocular pressure(IOP),cornea,ciliary body and retina were recorded preoperatively,and 1 week,1 months,6 months.The intraoperative situation and postoperative complications were recorded as well.The position of the ciliary process and the distance between the ciliary process and the edge of the cornea were accurately located under endoscope.All operations were performed by the same surgeon under endoscope.Results:1.Basic data of patients:ECC groups were treated with ECC,14 cases(14 eyes),aged 18～68(42.3±15.3)years,Preoperative intraocular pressure 35.5～63.5(48.37±9.42)mmHg(1 KPA 7.5 mmHg),Among them neovascular glaucoma 4 eyes,Traumatic glaucoma,3 eyes,Uveitis secondary glaucoma 4 eyes,Other anti-green postoperative sustained intraocular pressure elevation of 3 eyes.ECP group underwent ECP therapy,22 patients(22 eyes),aged 16-71(40.6 ±20.6)years,intraocular pressure 36～62 mmHg(45.71±6.16)mmHg;Of these,6 were neovascular glaucoma,Congenital glaucoma 3 eyes,Traumatic glaucoma,3 eyes,Glaucoma secondary to vitreous surgery in 5 eyes,Other anti-green post--operative sustained intraocular pressure heigh of 5 eyes.2..Analysis of results of preoperative and postoperative two groups:,.In the ECC group,the mean intraocular pressure(IOP)decreased from 48.37±9.42mmHg preoperatively to 21.35±8.18 mmHg,19.07±4.82mmHg and 17.79±4.68 mmHg preoperative and postoperative lweek、lmonth and 6 months respectively.Regarding the ECP group,the mean IOP was reduced from 45.7l±6.16 mmHg to 19.49±5.83 mmHg,19.98±4.82 mmHg and 18.63.±5.01 mmHg at the same time intervals.IOP decreased significantly at 1 week、1month and 6 months after operation in both groups,IOP before and after operation was statistically significant(P<0.01),there was no significant difference in intraocular pressure between the two groups(P>0.05).The success rate of 1 week,1 month and 6 months in the ECC group was 57.1%,85.7%and 80.9%respectively.The success rate of 1 week,1 month and 6 months in the ECP group was 72.3%,68.2%and 84.6%respectively.There was no significant difference between the two groups(P>0.05);The preoperative BCVA of ECC group was～0.08,After operation,the ～was 0.2;At the last follow-up,5 eye vision improvement,6 eyes,3 eye vision loss,.The preoperative BCVA in ECP group was from 0.1～LP to LP～0.3postoperatively.At the last follow-up,the visual acuity of 8 eyes increased,10 eyes remained unchanged,and the visual acuity of 4 eyes decreased,There was no significant difference in visual acuity between the two groups;The main complications of the two groups were conjunctival hyperemia,edema,inflammatory exudation of anterior chamber and moderate hemorrhage of anterior chamber,all recovered within 1 month,no atrophy of eyebal and persistent low intraocular pressure were found in both groups.3.Influencing factors:One case in each group was treated again 2-3 months after operation because of uncontrollable high intraocular pressure.Conclusion:1.ECC is proved to be safe and effective methods in treating refractory glaucoma.2.ECC has similar seccess rate in treating refractory glaucoma compared with ECP.3.Accurate measurement of the position of the ciliary process through ECC intraoperative speculum to guide the positioning of traditional cylocryotherapy. |
PDF Full Text Request