Clinical Efficacy Of Ultrasound Cycloplasty In The Treatment Of Uncontrolled Intraocular Pressure After Filtering Surgery

Background and ObjectiveGlaucoma with uncontrolled intraocular pressure(IOP)after filtering surgery is a kind of refractory glaucoma.Most patients with ocular pain and discomfort,need repeated operations and long-term use of IOP lowering drugs,which causes psychological and physiological torture to patients and seriously affects their quality of life.The Ultrasound cycloplasty(UCP)which was developed recently,aims to achieve selective and precise coagulation of the ciliary body while sparing the adjacent ocular structures.At present,UCP has been widely used in the treatment of many kinds of glaucoma,but the application of uncontrolled IOP after filtering surgery has not been reported.The purpose of this study was to investigate the efficacy and safety of UCP in the treatment of the uncontrolled IOP after filtrating surgery,and the possible effects of quality of life.MethodsSelf controlled case series study.The study included glaucoma patients with uncontrolled intraocular pressure after filtrating surgery,underwent UCP which was performed by EyeOP1 from July 2018 to October 2019 in the Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University.All patients were followed up for at least 6 months,the IOP,the types of drugs used for lowering IOP,ocular pain levels and SF-36 score,the BVCA and corneal endothelial cell count were recorded before and after operation.Record the duration of operation and adverse reactions during and after operation.Calculate the success rate of operation at 6 months after operation.Use SPSS25.0 software to analyze the data statistically,P<0.05 indicates that the difference is statistically significant.ResultsA total of 28 patients(28 eyes)with glaucoma who with uncontrolled intraocular pressure after filtering surgery were included,including 15 males and 13 females,aged from 29 to 77(57.71±14.07)years.All patients completed UCP successfully,and the average duration of operation was 3～7 minutes.The success rate was 89.29%(25/28)after 6 mouths,and the complete success rate was 75.00%(21/28).After operation,the IOP decreased significantly from(45.82±8.81)mmHg before operation to(23.11±6.20)mmHg after 6 months,there were statistically significant differences in IOP before and after operation(F=54.523,P<0.05),and the IOP at each follow-up point after operation was significantly lower than that before operation(P<0.05).The percentage of intraocular pressure decreased after 6 months was correlated with preoperative intraocular pressure(P<0.05).The types of drugs for lowering intraocular pressure decreased from 3(2,3)before treatment to 0(0,0.75)after 6 months(P<0.05).After operation,the ocular pain of all patients was relieved.The pain level decreased from 2(2,2)before operation to 1(0,1)after 6 months(P<0.05).After operation,scores of SF-36 Quality of Life Scale in 8 fields were higher than those before operation,and the difference was statistically significant(P<0.05).BCVA(Log MAR)was(2.31±0.84)before operation and(2.26±0.84)after 6 months,there was no statistically significant difference before and after operation(P>0.05);The corneal endothelial cell count could be detected in 13 cases(13 eyes)before operation.The corneal endothelial cell count changed from(2137.2±249.4)cells/mm2 to(2081.9±250.2)cells/mm2 after 6 months.There was no significant difference before and after operation(P>0.05).During and after treatment,there were no serious adverse reactions such as macular edema,severe hypotension(IOP≤5mmHg),choroidal detachment and eyeball atrophy,Adverse reactions during operation:eye pain in 10 eyes(35.71%);Adverse reactions after operation:anterior chamber inflammation in 6 eyes(21.42%),conjunctival edema and congestion in 19 eyes(67.86%),corneal edema in 3 eyes(10.71%)and transient intraocular pressure elevation in 3 eyes(10.71%).The symptoms were relieved after symptomatic treatment.ConclusionsUCP in the treatment of uncontrolled intraocular pressure after filtering surgery can effectively reduce IOP,reduce the types of IOP lowering drugs,can relieve patients’ ocular pain and improve their quality of life to a certain extent.It has no serious adverse reactions and has good efficacy and safety.it can be used as a new choice for the treatment of refractory glaucoma.