Abstract
Purpose To compare the clinical efficacy, safety, and histological effect between ultrasound cycloplasty (UCP) and cyclocryotherapy in the treatment of neovascular glaucoma. Methods Two groups of neovascular glaucoma patients who underwent two types of treatment, respectively, namely, 26 patients treated by UCP and 23 by cyclocryotherapy, were treated and observed during the clinical study for six months. The primary outcome was evaluated by the surgical success, which was defined as the intraocular pressure (IOP) reduction of greater than or equal to 20% from the baseline and the IOP value of greater than 5 mmHg at the last follow-up. The secondary outcome referred to pain relief, complications, and the mean of the IOP at each follow-up. In the animal experiment, 18 New Zealand rabbits were divided into two groups and treated by UCP and cyclocryotherapy, respectively. The changes in the tissues and in the expression of matrix metalloproteinase-1 (MMP-1) were observed immediately. Results The mean IOP baseline for the UCP and cyclocryotherapy groups was 54.6 ± 9.7 mmHg and 53.3 ± 11.7 mmHg, respectively. After six months of follow-up, the IOP value decreased to 30.3 ± 9.4 mmHg for the patients treated by UCP and to 30.4 ± 9.1 mmHg for those treated by cyclocryotherapy. The two groups achieved a satisfying success rate in the treatment of neovascular glaucoma of up to 70% at least. Vision impairment was observed in some patients treated with cyclocryotherapy, and these patients suffered from more complications and less pain relief than the patients who were treated with UCP. The histological study showed that the ciliary body was completely destroyed after cyclocryotherapy and that MMP-1 was found only in the ciliary muscle. After the UCP treatment, MMP-1 could still be found in the ciliary body, and only the double-layer epithelial cells presented with coagulative necrosis. Conclusion The UCP treatment and cyclocryotherapy both showed good efficacy in significantly reducing the IOP. However, the UCP treatment was safer with less postoperative complications and adverse effects. Thus, the overall treatment effect of the UCP was more efficient than that of cyclocryotherapy.
Highlights
Neovascular glaucoma (NVG) is a type of refractory glaucoma associated with a complex etiology and a significant risk of blindness
Ultrasound biomicroscopy (UBM), axial length, and white-to-white distance measurements were performed before the ultrasound cycloplasty (UCP) treatment to define the probe size to be used for each patient
Histology. e high intraocular pressure (IOP) model was induced by the compound carbomer in 18 New Zealand rabbits, which were divided into the UCP treatment group and the cyclocryotherapy group
Summary
Neovascular glaucoma (NVG) is a type of refractory glaucoma associated with a complex etiology and a significant risk of blindness It is characterized by the occurrence of new vessels in the iris and angle that is difficult to deal with [1]. Many surgical methods can be used to reduce the IOP in NVG Surgeries such as trabeculectomy, drainage valve implantation, cyclocryotherapy, and diode laser ring photocoagulation, among others, are commonly performed in clinical practice. Drainage valve implantation, cyclocryotherapy, and diode laser ring photocoagulation, among others, are commonly performed in clinical practice Among these procedures, cyclocryotherapy has been used to treat NVG since the 1960s. Cyclocryotherapy has been used to treat NVG since the 1960s It can reduce the production of aqueous humors and can increase its outflow. To understand the efficacy of the two procedures, this study compared the UCP treatment and cyclocryotherapy in terms of the IOP reduction, pain relief, and possible complications
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