|Year : 1984 | Volume
| Issue : 2 | Page : 77-80
Cyclocryotherapy in absolute glaucoma
Ajit Sinha, A Rahman
Department of Ophthalmology, Nalanda Medical College Hospital Patna, India
9/84 Officer's F1aLNew Punaichak, Patna
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sinha A, Rahman A. Cyclocryotherapy in absolute glaucoma. Indian J Ophthalmol 1984;32:77-80
The treatment of absolute glaucoma has remained unsatisfactory. In the past, cyclodiathermy, retrobulbar injection of alcohol and enucleation have been extensively practised among them.
Cyclocryotherapy for the treatment of glaucoma was first reported by Bietti in 1950. Later on, much work has been done on cyclocryotherapy on various types of glaucoma by different authors.,,,,,,, But very little work has been done in absolute glaucoma cases so far, and in those cases too, the results were inconsistent,.
| Material and methods|| |
114 patients (120 eyes) of absolute glaucoma were subjected to cyclocryotherapy [Table - 1]. The diagnosis of absolute glaucoma was based on detailed history and thorough ophthalmic examinations like visual acuity, ophthalmoscopy, measurement of intraocular tension and gonioscopy (where possible), biomicroscopy and facility of aqueous outflow.
Under surface anaesthesia and retrobulbar injection of 2% Xylocain, circular and convex retinal cryo-probe with a diameter of 4 mm. was applied directly on the intact conjunctival surface, the centre of the tip being 4 mm from the limbus, for 1 minute at about-60° to -65°, thus being directly over the ciliary body [Figure - 1]. The probe left good ice-craters on the conjunctival surface for a few seconds after its removal [Figure - 2]. In all cases the probe was applied in such a way that the margin of the ice-craters touched one another on each application, and the applications were given all round the limbus [Figure - 3], except in first twelve eyes where it was applied in the upper half only. Following cryosurgery the eyes were padded for 24 hours, using chloromphenical eye ointment which was then continued 4 times a day. No anti-inflammatory drug was used either locally or systemically. Only analgesics were given. The post-operative tension was checked after 24 hours, on the 7th day, 14th day, 6 weeks and 3 months after the operation.
| Observations|| |
The results of cyclocryotherapy are shown in [Table - 1]. in 12 eyes (10%) where the cryo was applied or. the upper half round the limbus in close contact with each other, only a slight fall in the ocular tension occurred. In 108 eyes (90%) the cryo was applied all round the limbus in close contact with each other. In 75 such cases (62.5%) the tension came down to within normal limits after single cryo treatment. 15 eyes (12.5%) showed only slight fall of tension, in which the cryo had to be repeated a second time after a few months and the intraocular tension came down to within normal limits in 12 eyes (1%). So the total number of eyes in which the intraocular pressure (single and repeat cryotherapy combined) was controlled, was 87 (72.5%). Among 3 eyes (2.5%) in spite of repeating the cryotherapy, the intraocular pressure could not be normalised. 4 eyes (3.33%) developed hypotony (below 7 mm Hg) after the initial procedure. 14 cases (11.66%) did not turn up regularly for fellow up but it was within normal limits as long as they came. Bilateral cyclocryotherapy was performed in 8 cases. In all cases pain and chemosis were marked post-operative features.
| Discussion|| |
In absolute glaucoma the ciliary body is functioning normally producing aqueous, but the outflow is obstructed for one reason or the other. So the intraocular pressure builds up causing pain to the patient and leading to a painful blind eye. We, therefore, decided to deal with the ciliary body, destroy it by cyclocryotherapy leading to diminished formation of aqueous, lower the tension and ameliorate the pain.
Cyclocryotherapy is another operative procedure for destroying the ciliary body. We decided to do cyclocryotherapy because it has an edge over cyclodiathermy as (i) the subfreezing temperature is less destructive to other structures of the eye, (ii) it can be safely repeated a number of times, (iii) it can be done as an outpatient procedure.
As the intraocular tension is very high in absolute glaucoma cases, we decided to give cryo applications touching one another all round the limbus so that larger area of the ciliary body was treated, We thus achieved better results by our technique, having failed earlier in 12 cases where we applied cryo in upper half of the globe only. Other workers2-8 treating primary, secondary and congenital glaucoma cases, but not absolute glaucoma cases, used 6 to 12 equidistant applications and were able to normalise the pressure in such cases.
Treating larger number of cases by our technique we found that the tension fell down to within normal limits in 72.5% of the eyes (single and repeat cyclocryotherapy combined). We also failed in those 12 cases in which we applied cryo in close contact with each other around half of the globe only. Very little work has been done by others with cyclocryotherapy in absolute glaucoma cases. Misiun and Krwawicz et al were not able to achieve satisfactory fall of tension after cryotherapy in absolute glaucoma cases by their own technique.
12.5% of the eyes in our series needed a repetition of cryo, 2.5% of which failed to respond. Other workers,,,,, repeated the procedure varying from 8% to 43.47% of the eyes and among them 5.26% to 8.19% failed to respond.
In our series hypotony (below 7 mmHg) was noticed in 4 eyes (3.3%) after single cryo treatment, whereas other workers ,,,, got it ranging from 2.77% to 31.57% in their series of eyes.
No anti-inflammatory drug was used in our series as it suppresses the sterile ciliary reaction that sets in following cyclocryotherapy, whereas other authors,,,,,,, have used corticosteroids either topically or systemically.
In the end, it must be emphasised that cyclocryotherapy is a very simple procedure, can be done as an outdoor procedure, is comparatively free from complications.
| Summary|| |
120 eyes of absolute glaucoma which underwent cyclocryotherapy have been reported. The results were encouraging. 72.5% of the eyes in our series were well controlled in which the cryo was applied in close contact with each other all round the globe, single and repeat cryo treatment combined.
| References|| |
Bietti G., 1950, cited by deRoetth A., 1966, Amer. J. Ophthalmol., 61: 443.
deRoetth A., 1966, Amer. J. Ophthalmol., 61: 443
de Roetth A., 1968, Amer. J. Ophthalmol., 66: 1934
Bellows A.R, and Grant W.M., 1973, Amer. J. Ophthalmol. 75: 679
Binder P.S., Abel R., and Kaufman H.E.m 1975 Amer. J. Ophthalmol., 79:489
West CE., Wood T.O., and Kaufman H.E., 1973, Amer. J. Ophthalmol., 76:485
Krupin T., Mitchel KB., and Becker B., 1978, Amer.J. Ophthalmol., 86: 24 ,
Krupin T., Johnson M.F., and Becker B., 1977, Amer. J. Ophthalmol., 34:426
Feibel RM. and Bigger J.F., 1972, Amer. J. Ophthalmol., 74: 862
Misiun F.A., 1970, Oftal. Zh., 25: 40
Krwawicz T., and Szwarc B., 1965, Klin. Oczna, 35:191.
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]