ABSTRACT
To compare the benefits and risk rates of contact transscleral cyclodiode and cyclocryo therapy in some cases of refractory glaucoma. This study comprised 68 eyes of 68 patients with neovascular [34 eyes] and aphakic glaucoma [34 eyes]. All patients had pretreatment visual acuity of less than 6/60. Either contact transscleral cyclodiode or cyclocryo therapy was applied consecutively to the eyes of the included patients. Posttreatment follow up was done for 6 up to 12 months. Cyclodiode therapy was successful in 70.6% of the cases. The mean IOP reduction effect was 15.77 +/- 5.04 mmHg. IOP reduction effect of cyclodiode was higher in neovascular glaucoma [17.9 +/- 4.7 mmHg] than in aphakic glaucoma 13.5 +/- 5.39 mmHg. Pretreatment ocular pain was relieved in 37.5% of patients. The mean number of pretreatment topical antiglaucoma medications was reduced from 2.4 to 1.5. Visual acuity was stable in 73.5%, improved in 5.9% and decreased in 20.6% .The only recorded complication was transient hyphaema in one eye. Cyclocryo therapy was successful in 67.6%. The mean IOP reduction effect was 15.9 +/- 5.23 mmHg. IOP reduction effect of cyclocryo was higher in aphakic glaucoma 19.05 +/- 5.32mmHg, than neovascular glaucoma 12.8 +/- 5.06 mmHg. The pretreatment ocular pain was relieved in 77.8%. The mean number of pretreatment topical antiglaucoma medications was reduced from 2.52 to 1.57. Visual acuity was stable in 67.6%, and decreased in 32.4%. Complications after cyclocryotherapy were recorded in 8 eyes [23.5%], in the Form of complicated cataract [5.9%], recurrent hyphaema [2.9%], uveitis [2.9%], CRV occlusion [2.9%], vitreous haemorrahge [2. 9%], and atrophia bulbi in [5.9%] of the cases. In patients with refractory glaucoma, both transscleral Cyclodiode and cyclocryo therapy are effective means to reduce IOP, however post cyclocryo complications still an important concern. The success of these two procedures depend on type of glaucoma
Subject(s)
Humans , Male , Female , Ophthalmologic Surgical Procedures/methods , Comparative Study , Follow-Up Studies , Intraocular Pressure , Postoperative Complications , Visual AcuityABSTRACT
To better understand the potential association of serum levels of interleukin- I beta [IL-1B] and interleukin-1 receptor antagonist [IL-1ra] with diabetic rnicroangiopathy, serum concentrations of IL-1B and IL-1ra were determined in 42 patients with diabetes mellitus [22 non Insulin dependent diabetes mellitus [NIDDM] and 20 insulin dependent diabetes mellitus [IDDM]] presenting with varying degrees of diabetic status and late complications. They were compared with 26 age and sex matched healthy subjects. Our results revealed that the concentrations of IL-1B and IL-1ra were elevated in diabetic patients versus control [Mean +/- SE 0.9 +/- 0.25pg /ml for IL-1B and 752.8 +/- 53.7pg / ml for IL-1ra in diabetics vs 0.08 +/- 0.04pg /ml for IL-1B and 446.6 +/- 40.5pg /ml for IL-1ra in the control, P = 0.01 and P< 0.0001 respectively]. Patients with diabetic retinopathy [n = 16] had the highest concentrations of serum IL-1B compared to those with neuropathy [n = 14] and to those with uncomplicated diabetes [n = 12] [Mean +/- SE 1.78 +/- 0.54pg /ml vs 0.37 +/- 0.32pg /ml and 0.35 +/- 0.16 pg /ml respectively, P = 0.05] IL-1ra levels were the highest In patients with diabetic neuropathy compared to those with retinopathy and uncomplicated diabetics [Mean +/- SE 905.9 +/- 95.2pg /ml vs 749.9 +/- 93.9pg /ml and 578.02 +/- 61.8pg/ml respectively. P<0.05]. Patients with proliferative diabetic retinopathy [n = 10] had significantly higher levels of IL-1B compared to those with non proliferative retinopathy [n= 6] [Mean +/- SE 2.7 +/- 0.71pg /ml vs 0.23 +/- 0.15pg /ml, P< 0.01]. IL-1ra / IL-1B ratio was lowest in patients with diabetic retinopathy especially the prolifertive type and highest in those with neuropathy with uncomplicated diabetics having intermediate values comparable to that of the control [P>0.01], Analyzing pooled data from diabetic patients, a weak negative correlation was found between IL-1B and IL-1ra [r = - 0.22, P> 0.05]. Interstirigly IL-lB was significantly correlated with HDL-cholesterol whereas IL-1ra was significantly correlated with serum triglycerides. IL-1ra/IL-1B ratio was significantly correlated with serum total cholesterol and HDL cholesterol. [r= 0.36 r = 0.38, r = 0.35 and r =-0.34 respectively]. Serum levels of IL-B and IL-1ra are elevated in diabetic patients with and without microangiopathy reflecting ongoing inflammation and macrophage endothelial cell activation. Elevated levels of IL-1B and decreased IL-1ra/IL-1B ratio point more to proliferative retinopathy whereas high levels of IL-1ra and IL-1ra/IL-1B ratio may give an idea about the presence of neuropathy