Clinical Study On Treatment Of Refractory Glaucoma With Endoscopic Cyclophotocoagulation

Objective:To explore the clinical efficacy and safety of endoscopic cyclophotocoagulation(ECP)in the treatment of refractory glaucoma.Methods:Twenty-three patients(Twenty-three eyes,including sixteen cases of neovascular glaucoma,five cases of secondary glaucoma after trauma,one case of high intraocular pressure after antiglaucoma operation and one case of secondary glaucoma after vitrectomy)who were treated with ECP in ophthalmology of the second hospital of Hebei medical university for refractory glaucoma from January 2019 to January 2020 were included in this study.All patients underwent BCVA,intraocular pressure(IOP),slit lamp,gonioscopy and fundus examination before the operation.Patients with neovascular glaucoma received intravitreal injection of anti-VEGF drugs at first.ECP treatment was performed with iop of > 30 mm Hg with 2 or more antihypertensive drugs after iris neovascularization has subsided.The photocoagulation range was determined according to the preoperative intraocular pressure of the patients,with an average of 196.1°±32.2° and the laser energy was(0.4±0.1)W.Patients with neovascular glaucoma were treated with pan-retinal photocoagulation before or during and after surgery.The follow-up period was 6 months to 13 months.Observe and compare the changes of BCVA,iop,anterior segment and ciliary body before and after operation,as well as the number of drugs used to reduce iop,and record the occurrence of intraoperative and postoperative complications.Results:A total of 23 patients(23 eyes)were included in the study,and the average age was(59.3±14.3)years.The average intraocular pressure was(53.4±11.3)mm Hg before the operation;The average intraocular pressure was(31.8±6.8)mm Hg 1 week after the operation.The average intraocular pressure was(18.6±3.2)mm Hg 1 month after the operation.The average intraocular pressure was(20.6±4.1)mm Hg 3 months after the operation.The average intraocular pressure was(20.3±3.5)mm Hg 6 months after the operation.The IOP at 1 week,1 month,3 months,and 6 months after operation were all lower than those before surgery,and the difference was statistically significant(P <0.05).Two patients received the second ECP treatment due to poor intraocular pressure control,the follow-up period was 3 months and the intraocular pressure was ?21mm Hg.The best corrected visual acuity at 6 months after surgery comparing with that before surgery,seven cases(seven eyes)with slightly improved vision,accounting for 30.4%,sixteen cases(sixteen eyes)with no significant change in vision,accounting for 69.6%,and none of them had significant decrease in vision.The patients used an average of(3.6±0.5)IOP-lowing drugs before the operation,an average of(1.8±0.8)IOP-lowing drugs at 1 months after operation,an average of(1.4±0.8)IOP-lowing drugs at 3 months after operation,an average of(0.7±0.8)IOP-lowing drugs at 6 months after operation.There was a statistically significant difference in the number of IOP-lowing drugs used at 1 month,3 months and 6 months after surgery compared with that before surgery(P<0.05).There were no complications such as low intraocular pressure,ocular atrophy,hyphema,incision leakage,intraocular lens displacement,suprachoroidal hemorrhage,choroidal detachment,retinal detachment and endophthalmitis.Only 1 patient had fibrin exudation(occurred on the first day after surgery),which was treated with 20 mg methylprednisolone eyeball injection,and the exudation was basically absorbed 3 days after surgery.5 patients were followed up for 1 year,the iop remained stable,3 patients had improved vision,2 patients had stable vision,no patients had vision loss,the number of IOP-lowing drugs gradually decreases,and no complications occurred during the follow-up.The iris neovascularization in patients with neovascular glaucoma subsided 4?5 days after operation,and no iris neovascularization appeared in the follow-up period.The ciliary process at the photocoagulation site of ECP was significantly atrophic in UBM 3 months after ECP.Conclusion:1.ECP can effectively reduce intraocular pressure in patients with refractory glaucoma,and no visual impairment.It is a safe and reliable surgical method.2.The ECP laser energy can effectively act on the ciliary process,shrink the ciliary process,reduce the formation of aqueous fluid and increase aqueous humor drainage of the suprachoroidal lumen.The role of lowering intraocular pressure has a clear anatomical basis.3.ECP has certain repeatability,so it is safe and feasible to operate again.