Therapeutic Effect Of Two Surgical Methods For Refractory Glaucoma

Objective: Refractory glaucoma including neovascular glaucoma,primary filter surgery failed glaucoma,vitreoretinal surgery failed glaucoma,traumatic glaucoma and secondary uveitis glaucoma.The treatment of refractory glaucoma is very difficult and becomes one of the main causes of blindness eye diseases.The purpose of this study is to observe the clinical efficacy and safety in the treatment of refractory glaucoma by two kinds of cyclodestructive procedures.Provide a reference for clinical to choose.Methods:A retrospective study of 50 patients(50 eyes)with refractory glaucoma diagnosed in our hospital between January 2018 and October 2018.Ultrasound ciliary plasty(UCP)were performed on 30 eyes and cyclocryotherapy were performed on 20 eyes.Intraocular pressure(IOP),pain grade scores and complications after operation were followed up for 3 months(mo).Repeated measurement of IOP at multiple time points was performed by ANOVA.The Independent-Sample test was used to compare the IOP among the two groups,IOP of each time point in both group was compared by LSD-t test.Mixed effect model was used to compare the pain grade scores.Results : The average IOP of the UCP group on 1d,1wk,1mo and 3mo were 29.27±10.40,23.87 ± 8.61,25.27 ± 9.95 and 23.70 ± 10.06 mm Hg compare with 43.97 ±10.39 mm Hg.The average IOP of the cyclocryotherapy group on 1d,1wk,1mo and 3mo were 22.15±7.78,20.80±8.44,22.50±7.12 and 24.20±8.43 mm Hg compare with47.30±8.53 mm Hg.The IOP in both group was significantly reduced(P<0.01).The average pain grade scores of the patients in the UCP group on 1d,1wk,1mo and3 mo after surgery were significantly lower than those before operation(P<0.05),but there was no significantly difference in the cyclocryotherapy group at 1d after surgery(P>0.05).there were no serious complications in the UCP group,four eyes appeared conjunctival hyperemia and one eye appeared superficial punctuate keratitis but there were 16 eyes(80%)in the cyclocryotherapy group: ten eyes appeared conjunctival hyperemia and six eyes appeared anterior chamber hemorrhage.Conclusion: 1.Both two operations can significantly reduce the IOP,but the IOP during the 3-month follow-up showed a rising trend compare with pre-operation.2.The pain grade scores of the patients in the UCP group was lower than those in the cyclocryotherapy group after operation.UCP with less pain,fewer complications and repeatable.3.The complications in the cyclocryotherapy group were significantly higher than those in the UCP group.UCP is safe and convenient surgery for refractory glaucoma and has significant effect on reducing intraocular pressure.