|Year : 1983 | Volume
| Issue : 6 | Page : 771-772
Cyclocryotherapy in juvenile glaucoma
HC Agarwal, B Ghosh, NN Sood
Dr. Rajendra Prasad Centre for Oph. Sciences, AIIMS, New Delhi, India
H C Agarwal
Dr. Rajendra Prasad Centre for Oph. Sciences, AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwal H C, Ghosh B, Sood N N. Cyclocryotherapy in juvenile glaucoma. Indian J Ophthalmol 1983;31:771-2
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%,.
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|| |
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|| |
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|| |
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., 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.
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|| |
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|| |
Sugar, H.S., 1968, Eye, Ear, Nose, Threat Mon.47:165.
Sood, N.N. Agarwal H.C. and Kalra, B.R., 1982 All India Ophthalmological Conference, Calcutta.
de Boeth A., Jr., 1968, Amer J. Ophthalmol. 66:1034.
de Boeth A. Jr., 1966, Amer. J. Ophthalmol, 61:443.
Burten T.C., 1974, Cyclycryotherapy Current concepts in Ophthalmology, Vol. IV, Chapter 9, 103.
[Table - 1], [Table - 2]