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ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 6  |  Page : 771-772

Cyclocryotherapy in juvenile glaucoma


Dr. Rajendra Prasad Centre for Oph. Sciences, AIIMS, New Delhi, India

Correspondence Address:
H C Agarwal
Dr. Rajendra Prasad Centre for Oph. Sciences, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 6676264

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How to cite this article:
Agarwal H C, Ghosh B, Sood N N. Cyclocryotherapy in juvenile glaucoma. Indian J Ophthalmol 1983;31:771-2

How to cite this URL:
Agarwal H C, Ghosh B, Sood N N. Cyclocryotherapy in juvenile glaucoma. Indian J Ophthalmol [serial online] 1983 [cited 2020 Jun 5];31:771-2. Available from: http://www.ijo.in/text.asp?1983/31/6/771/29322

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Table 1

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Table 1

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Juvenile Glaucoma though less common than adult onset glaucoma, nevertheless oc­cupies a place of its own in the sphere of ophthalmology. The success rate of conven­tional anti glaucoma survery in such cases is no better than 60%[1],[2].

Cyclocryotherapy in juvenile age group,however, has not been fully evaluated. An attempt has therefore been made to high­light the results of cyclocryotherapy in a vari­ety of cases below the age of forty years.


  Material and method Top


49 eyes forming the study were placed under four broad groups [Table - 1]. There were 3 eyes with congenital glaucoma, 8 eyes with primary glaucoma, 4 eyes each of aphakic and neovas­cular glaucoma and 25 eyes of other types of secondary glaucome. Of the group comprising secondary glaucoma, most of the cases were of post traumatic type.

All eyes were in the advanced stage of the disease where maximal medical and or surgical therapy had failed. All the cases underwent a 360° cyclocryotherapy in a single freeze thaw cycle of 60 seconds and 15 seconds respectively at -60° C with a probe diameter of 2.5 mm. The results were assessed in terms of intraocu­lar pressure control as well as rules of pain when present preoperatively, after atlest 6 weeks of follow up. Intraocular pressure was taken as controlled if it was 22m. of Hg or less in the follow up period.


  Observations Top


The mean precyclocryo intraocular pressure was 61.5 mm. of Hg with a range of 31.8 mm. Hg to 81.3 mm. of Hg. Following cycloc­ryotherapy of intraocular pressure came down to a mean of 22.8 mm Hg with a range of 8.5 mm. Hg to 43.4 mm. Hg. The overall control of IOP obtained was 55.1%. The percentage control in various age groups and in various types of glaucoma is shown in [Table - 1][Table - 2].


  Discussions Top


Cyclocryotherapy has given a big boost to the management of refractory and severe glaucoma. Though it is still being used only as a last resort its pressure lowering effect is well known. This mode of therapy procedure bet­ter control of intraocular pressure in older in­dividuals and pigmented eyes.[3],[4] Further it has also been documented that 12-14 evently placed cryspots, with a proble size of 2.5 mm. at -60° for 1 minute produces on adequate overall destruction of cilliary epithelium in human eyes.[5]

It is noticeable that following the procedure the intraocular pressure had a significant fall in all the cares e.g. from a mean of 61.5 mm. Hg to 22.8 mm. Hg. Further on interesting rela­tion of control rate is observed with the age, the control rate successively increasing from about 45% in the 1-10 years are group of 62% in the 31-40 years age group. A significant dif­ferent in the intraocular pressure control is noticeable in the age group below and above 20 years of age. The mean control rate of 61.3% above 21 years of age suddenly drops down to 49.1% below 20 years of age irrespec­tive of the type of glaucoma. The success rate in childhood glaucoma as previously described has not been very encouraging being 20. 4 and 38.5% 4. In this series nearly 50% of the cases below 20 years of age were controlled. This discrepancy may be accountable by curtain facts. In both the previous studies described only180° of area had been covered. Secondly these results have been reported with respect to childhood glaucoma, which might be in­cluding not only primary congenital glaucoma but also secondary glaucoma in the childhood.

The cilliary epithelium being more affected in porimary glaucoma as compared to secondary glaucoma behaves differently on being sub­jected to cyclocryotherapy, and hence the over, all poorer result, in previous studies as com pared to the present series. But better control in this series of 62.5% in cases of primary glaucoma, as compared to 42.3% in cases of secondary glaucoma further substantiate this fact.


  Summary Top


Results of cyclocryotheraphy in 49 eyes of juvenile cases of various types of glaucoma have been evaluated. A significant fall in IOP was observed in all the cases e.g. from a pre­cyclocryo mean of 61.5%mm Hg to a post cyc­locryo mean of 22.8 mm Hg of I.O.P. The central rate was related to the age of the Indi­vidual i.e. younger the age, poorer the control and vice versa. A significant difference in con­trol of IOP was else observed below and above the age of 20 years. Secondary glaucoma in general fair poorer as compared to primary glaucomas even in the juvenile age group.

 
  References Top

1.
Sugar, H.S., 1968, Eye, Ear, Nose, Threat Mon.47:165.  Back to cited text no. 1
    
2.
Sood, N.N. Agarwal H.C. and Kalra, B.R., 1982 All India Ophthalmological Conference, Calcutta.  Back to cited text no. 2
    
3.
de Boeth A., Jr., 1968, Amer J. Ophthalmol. 66:1034.  Back to cited text no. 3
    
4.
de Boeth A. Jr., 1966, Amer. J. Ophthalmol, 61:443.   Back to cited text no. 4
    
5.
Burten T.C., 1974, Cyclycryotherapy Current con­cepts in Ophthalmology, Vol. IV, Chapter 9, 103.  Back to cited text no. 5
    



 
 
    Tables

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