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   Table of Contents      
ORIGINAL ARTICLE
Year : 1984  |  Volume : 32  |  Issue : 4  |  Page : 209-211

Observations on the use of low temperature in the treatment of glaucoma


Clinic of Ophthalmology, Medical Academy in Lublin, Poland

Correspondence Address:
Kazimierz Gerkowicz
Clinic of Ophthalmology. Chmielna 1, 20-079 Lublin
Poland
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Source of Support: None, Conflict of Interest: None


PMID: 6571501

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How to cite this article:
Gerkowicz K, Toczolowski J. Observations on the use of low temperature in the treatment of glaucoma. Indian J Ophthalmol 1984;32:209-11

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Gerkowicz K, Toczolowski J. Observations on the use of low temperature in the treatment of glaucoma. Indian J Ophthalmol [serial online] 1984 [cited 2020 Nov 29];32:209-11. Available from: https://www.ijo.in/text.asp?1984/32/4/209/27390



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Bietti[1] was the first to use low temperature for the treatment of glaucoma, but it was only in the '60s that this method gained wider application, thanks to the publication of a greater number of experimental and clinical studies[2],[3],[4]. The general opinion is that cyclocryoapplication represents in many forms of glaucoma, an efficacious therapeutic method[5],[6],[7],[8]. Although no uniform techni­que of this operation has been established so far[9] with the result that the methods of apply­ing low temperature and the reports on their efficacy show considerable differences. In the present work, two groups of patients are com­pared, in whom two different methods of per­forming cyclocryoapplication were applied in various clinical forms of glaucoma.


  Material and methods Top


The patients were divided into two groups: group I consisted of 39, and group 2 of 44 patients. All operations were performed under topical anaesthesia. A cryoprohe with a ball shaped tip of a 2.5 mm diameter was ref­rigerated to about-74°C and applied in the region of the ciliary body, with a pressure which caused some indentation of the sclera. The operation consisted of 5-6 applications in the two upper or lower quadrants of the eyeball.

In patients of group 1, the cryo-probe was applied at a distance of about 0.5-1 mm from the limbus, for 30 sec. In patients of group 2, care was taken to maintain a 1 mm distance from the limbus in the lower quadrants, and a 1.5 mm distance in the upper ones, the dura­tion of each application being 60 sec. [Figure - 1].

An increased intraocular pressure, which did not respond to conservative treatment, was found in all patients prior to the opera­tion. Control examination and comparison of tonometric results were carried out 6 to 8 weeks after cryoapplication. The effects of the operation were classified as follows:no reduc­tion of the intraocular pressure /0/; partial reduction, the pressure still remaining above 30 mmHg /+/; reduction of the pressure to normal limits /++/.


  Observations Top


The results obtained in both groups of patients are presented in [Table - 1][Table - 2].

In group 1, normal intraocular pressure was found in 31% of patients, partial reduc­tion in 26%, and in the remaining 43% cycloc­ryoapplication had no effect on the intra ocular pressure. The respective figures in patients of group 2 were 57%, 23% and 20%.

No case of hypotony was observed in both groups, either immediately after the operation or during the first post-operative days, the intraocular pressure never falling below 18-20 mmHg. As a complication during the early post-operative period, hemorrhage into the anterior chamber occurred in 3 patients of group 2; two of them had hemorrhagic glaucoma, and one had diabetic retinopathy. Blood was resorbed after instituting conser­vatrive treatment.


  Discussion Top


Most authors perform cyclocryoapplica­tion using temperatures ranging from-70 to -80°C. This preference is supported by experimental studies, which have demonst­that no therapeutic effect can be obtained with higher temperatures[5],[7],[10] and that with too low temperatures the risk of phthiris bulbi presents itself[6],[7].

An essential element of the operation is the duration of the individual applications of the instrument. According to Faulborn and Birnbaum[11] the intended effect of cycloc­ryoapplication, consisting in reducing the secretion of the aqueous in consequence of damaging the epithelium of the ciliary pro­cesses, is obtainable when temperatures between-60 and -80°C act for 60 sec. For this reason, we thought it indicated to extend the duration of each application from the 30 sec. used in group 1, to 60 sec.

It is known that the best effect of cycloc­ryoapplication is obtained when the ciliary processes are refrigerated from their base to the apex. The instrument should therefore be applied immediately over the pars plicata of the ciliary body. Measurements of human eyeballs demonstrate that the most reason­able method of performing cyclocryoapplica­tion is to maintain the distance between the anterior contour of the cryoapplicator and the limbus at 1 mm in both lower quadrants, and at 1.5 mm in both upper ones[12].

The therapeutic results obtained in glaucomatous patients of group 2 seem to confirm the soundness of the cyclocryoap­plication modification under discussion[8]. In this group, comparable with group 1 as far as the diagnosed forms of glaucoma are con­cerned, normalization of the intraocular pre­ssure was observed almonst twice as often. We think it therefore advisable to perform cycloc­ryoapplication by the method described for our group 2 of glaucomatous patients.


  Summary Top


Comparison is made between the results of cyclocryoapplication obtained in 2 groups of

patients with similar clinical forms of glaucoma. With the same temperature of the instrument and the same diameter of its tip, in one group the cryoaplicatorwas applied at the distance of about 0.5-1 mm from the limbus: for 30 sec. In the other group, the distance of the instrument from the limbus was 1.5 mm in the upper quadrants of the eyeball, and I mm in the lower ones, and the duration of each application was 60 sec. Normalization of the intraocular pressure was distinctly more fre­quent in patients of the latter group.

 
  References Top

1.
Bietti, G., 1950, JAMA 142:889.  Back to cited text no. 1
    
2.
Kelman,C.D., 1966, Atlas if cryosurgical techniques in ophthalmology. C.V. Mosby Co.. St. Louis.  Back to cited text no. 2
    
3.
Krwawicz, T., Szware, B... 1965. Klin. Oczna 35:191.   Back to cited text no. 3
    
4.
Lincoff, H., Gavero, R., Nadel. A., Me Lean J.M.. 1968, AMA Arch. Ophthalmol. 79:196.  Back to cited text no. 4
    
5.
Bellows, AR_ Grant, W.M.. 1978, Amer. J. Ophthal­mol. 85:615.  Back to cited text no. 5
    
6.
Forlani, D., Tiberio. C., Negroni, L.,1970, Min. Mbl. Augenhelik. 55 Beiheft 163:63.  Back to cited text no. 6
    
7.
Haddad. R, 1981, Wien. Klin. Wochenschr. Suppl. 126 93:3.  Back to cited text no. 7
    
8.
Gerkowicz, K, Tocxolowski, J., Grunwald, W., Klin. Oczna/in Press/.  Back to cited text no. 8
    
9.
Prost, M., 1983, Surv. Ophthalmol. 28:93.  Back to cited text no. 9
    
10.
Bellows, A.R, Grant, W.M., 1973, Amer. J. Ophthalmol. 75:676.  Back to cited text no. 10
    
11.
Faulborn, J., Birnbaum, F., 1977, Min. Mbl. Augenheilk. 170:651.  Back to cited text no. 11
    
12.
Prost, M., 1984, Ophthalmologica/Basel/188:9.  Back to cited text no. 12
    


    Figures

  [Figure - 1]
 
 
    Tables

  [Table - 1], [Table - 2]



 

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