| Objective: Refractory Glaucoma is a class of glaucoma in which it is verychallenging to control intraocular pressure within the normal range, despiteconventional filtration surgery alone or in combination with anti-metabolite drugs,surgery involving the destruction of the ciliary body or a combination therapycomprising of anti-glaucoma drugs with the maximum tolerated dose. For this type ofadvanced glaucoma, surgical destruction of the ciliary body is currently being used toachieve lower intraocular pressures, relieving ocular pain, headaches and othersymptoms. As for its tissue damage, poor repeatability,serious and morecomplications, cyclocryotherapy is applied limitly. In recent years, Transscleraldiode laser cyclophotocoagulation (TSCP) is used in the clinic for the treatment ofrefractory glaucoma, and achieved good results.It also has few complications, highrepeatability and good tolerance. However,it is not clear for relation of the curativeeffect and the laser energy,points and ambit. This study assesses patients diagnosedwith Refractory Glaucoma who underwent TSCP treatment on the observation ofpostoperative visual acuity, intraocular pressure and complications, to verify theefficacy of the treatment of refractory glaucoma under TSCP,also to investigate the effects of different causes and intraoperative surgical approach and methods,finally,inorder to improve the clinical efficacy of TSCP.Methods: Data of patients with refractory glaucoma was collected at theOphthalmic Clinic at Second Affiliated Hospital of Dalian Medical University.According to the etiology, the patients are divided to the group of non-absoluteprimary glaucoma (group A), the group of absolute primary glaucoma (group B) andthe group of secondary glaucoma (group C). Furthermore, according to the differentways to select the laser-determined power, these three groups were sub-divided intotwo groups. TSCP was given to patients and the curative effect was observed after thetreatment. The obtained data was statistically analyzed using SPSS19.0software.Results:1. Between December2012and December2013, a total of60patients(63eyes) with refractory glaucoma under Transscleral Diode LaserCyclophotocoagulation.The intraocular pressure is ranged from (49.13±14.44)mmHg to(26.40±11.57) mmHg, and showed statistically significant differencebetween the values (P=0.000<0.05). In addition to the first postoperative day, allthree groups A, B and C had lower postoperative IOP and showed statisticallysignificant difference between the values (P <0.05), indicating that different etiologyleads to the different effect after laser treatment, and in group C, IOP has lowermagnitude than the other two groups, while no significant difference was revealedbetween the first and second group in comparison of postoperative IOP reductionvalue (P>0.05).2. There are47eyes in visual acuity unchanged,10eyes in visual acuityimproved,6eyes in visual acuity reduced. In group A, vision changed mostvolatile. And there is no significant difference between the first and second group incomparison of visual reduction value (x2=1.081, P>0.05).3. Most postoperative ophthalmagia is rereleased.There is the only one undereyeball ablation,which ophthalmagia was no rereleased. The results show thatsignificant difference between the first,second, third day and peroperative incomparison of pain symptom (U=5.729，P<0.05；U=7.347，P<0.05；U=8.294，P<0.05).And the complication is under the low degree. 4.Pearson correlation analysis shows that, before and after surgery, intraocularpressure difference associated with etiology, with the correlation coefficient r=0.417,P=0.001<0.05, is statistically significant. Positive correlation between preoperativepressure, and its related coefficient r=0.879, P=0.000<0.05. But age, gender andchoice to energy appear to be not associated with effect.5. Plottthed line chart of IOP changes over time, shows that as postoperative IOPbegins to decline and then, gradually increases. At the end of the first seven days, itreaches its lowest value, and then it increases slightly, and remains stable up to amonth period.Conclusion:1. Good results and fewer complications were achieved in thetreatment of Refractory Glaucoma with the Transscleral Diode LaserCyclophotocoagulation, which itself has the advantages of being a simple surgicaloperation and has fewer complications.2. The curative effect of using Transscleral Diode Laser Cyclophotocoagulationin the treatment of Refractory Glaucoma is related to the etiology and peroperativeintraocular pressure, but has no significant correlation to the patient’s gender, age orthe laser energy level’s blasting sound.3. General rules of the IOP changes, in the treatment of Refractory Glaucoma byusing Transscleral Diode Laser Cyclophotocoagulation is that intraocular pressurecontinues to decrease, even at a week after reaching its the lowest value, and remainsstable up to a month period. |
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