|Year : 1987 | Volume
| Issue : 3 | Page : 149-152
Cyclo-cryo therapy in glaucoma of advanced stage
RC Saxena, Jaswant Singh
Deptt of Ophthalmology, KG's Medical College, Lucknow 226 003, India
R C Saxena
Deptt of Ophthalmology, KG's Medical College, Lucknow 226 003
Source of Support: None, Conflict of Interest: None
In the present series an effort has been made to present cases of advanced glaucoma of different varieties treated with Cyclo-cryo therapy. It has been demonstrated that 76.9% of the eyes, are relieved of glaucoma easily by either single or a repeat therapy. Hypotony seen in 11.6% has been the worst complications.
|How to cite this article:|
Saxena R C, Singh J. Cyclo-cryo therapy in glaucoma of advanced stage. Indian J Ophthalmol 1987;35:149-52
| Introduction|| |
Treatment of various types of glaucoma in advanced stages remained unsatisfactory. The long term use of arbon anhydrase inhibitors and miotics is not practical. They are not fully effective. In some of these cases even filtering operations are occasionally successful. Short of enucleation, the only permanent method left in such eyes to relieve their symptoms is to decrease the aqueous humour formation by partially destroy ing the ciliary body by cyclo-diathermy or by cyclotherapy, cyclo-cryo therapy as observed by Shukla & Thakur , Sinha & Rehman  & Kafimer G and Jery T  in their studies show quite encouraging results to control intraocular pressure. The authors of this paper have treated some cases of advanced glaucoma by cyclo- cryo therapy the results of which are being presented with its procedure.
| Material and Method|| |
This study was carried on 26 eyes of 22 patients with glaucoma These included 8 eyes with "Neovascular glaucoma" (5 patients), 9 eyes with "aphakie glaucoma" (8 patients), 5 eyes with "absolute glaucoma" both after chronic simple glaucoma and chronic congestive glaucoma (5 patients), 3 eyes with secondary glaucoma due to leucoma adherens (3 patients) and I eye with secondary glaucoma following traumatic hyphaema (1 patient) [Table - 1]. All these cases had already been treated with medical and/or surgical methods, without or with only temporary relief.
Cryotherapy procedures were performed under topical and retrobulbar anaesthesia. Ten applications equidistant from each other were applied over the ciliary body region 2-3 mm behind the limbus over 360 degrees with 2.5 mm size retinal detachment cryo-probe.
We divided them into two groups One group included 9 eyes who had intra-ocular pressure upto 40 mm, to whom 60 seconds freeze thaw cycle was used and the second group included 17 eyes who had intraocular pressure above 40 mm, to whom freeze (60 seconds) thaw refreeze (30 sec) cycle was used [Table l]a,b. When intraocular pressure with single treatment remained inadequate, a repeat treatment was also given.
Eyes were treated post-operatively with topical cycloplegics and corticosteroids
The intraocular pressure response to therapy was determined as follows: (a) Intraocular pressure 10.2 to 22.2 mm of Hg. - Adequate response (b) Below 10.2 mm Hg - Excessive response (c) above 22.2 mm - inadequate response.
| Results|| |
The intraocular pressure response at the available follow up examinations in response to single cyclo,cryo therapy treatment is shown in [Table l]a,b.
As shown in [Table - 3], repeat treatment was done only in 4 eyes (2 eyes with neovascular glaucoma, I eye with aphakic glaucoma and 1 eye with absolute glaucoma) of the 4 eyes [Table - 1]. Eye having leucoma adherens with secondary glaucoma did not come for follow up. Out of these 4 eyes, 2 showed adequate response and in the other 2 eyes (one with neovascular glaucoma and 1 with aphakic glaucoma), intraocular pressure was not controlled even after repeat treatment although symptoms were relieved.
The overall response of intraocular pressure to different types of cyclo-cryo therapy cycles in different types of glaucoma is shown in [Table - 3].
| Discussion|| |
This study shows that cyclo-cryo therapy is effective in reducing the intra ocular pressure in eyes with glaucoma not controlled with other conventional methods. With single treatment either with 60 sec freeze thaw cycle or with 60 sec freeze thaw and 30 sec refreeze cycle, adequate response was observed in a total of 18 eyes (69.2% eyes (19.2%) however showed inadequate response and 3 eyes (11.6%) showed excessive response. The two eyes out of four (since one did not come for follow up) inadequate results also improved with repeat treatment Thus, adequate results were seen in a total of 20 eyes out of 26 eyes (76.9%). The other two who were given repeat treatment also improved a lot in their symptoms although their pressure remained above 22 mm, Schiotz It was a matter of concern in 3 eyes who developed hypotony. They were the cases of aphakic glaucoma where freeze thaw refreeze cycle was used showing that the ciliary body is more sensitive to freeze thaw refreeze cryo cycle.
As regards the complications besides lid oedema, conjunctival chemosis & iritis, impairment of corneal sensation were observed nearly in all cases, which were managed easily.
Cyclo-cryotherapy has an edge over cyclo-diather my firstly because the subfreezing temperature is less destructive to other structures of the eye. Secondly it can be safely repeated a number of times and finally, it can be an out patient procedure also.
| References|| |
M Shukla and N. Thakur Ind J. OphthaL 29: 13: 1981
A Sinha and A Rahman Ind J. OphthaL 32: 77: 1984
Kazinier C1 and Jery T. Ind J. OphthaL 32: 209: 1984
[Table - 1], [Table - 2], [Table - 3]