AIM: To evaluate the efficiency and safety of simultaneous, combined cryotherapy and alcohol injection in cases of secondary neovascular glaucoma with absolute vision loss and intolerable pain syndrome. Ocular pain due to glaucoma can be complex and difficult to treat. Therapy consists of topical and systemic pressure lowering agents, anti-inflammatory drugs, analgesics, surgical procedures - cyclocryotherapy, retrobulbar alcohol injection, enucleation or evisceration.
MATERIALS AND METHODS: We present 35 patients diagnosed with absolute glaucoma and treated with a combined technique - cyclocryotherapy and retrobulbar alcochol 96% 1ml injection. Verbal Analog Score (VAS) was used to evaluate the pain.
RESULTS: All of the patients (100%) were pain-free 12 months after the procedure. No significant long-term complications were observed.
CONCLUSION: This case study highlights that cyclocryotherapy combined with retrobulbar alcohol can play a significant role in the management of pain in patients with absolute glaucoma.
Lee WR, Absolute Glaucoma. Ophthalmic Hystopathology. London: Springer; 2002, p. 63-99.
Gessesse GW, Damji KF. Advanced Glaucoma: Management Pearls. Middle East Afr J Ophthalmol. 2013; 20(2):131–41. doi: 10.4103/0974-9233.110610
Chen TC, Ahn Yuen SJ, Sangalang MA, Fernando RE, Leuenberger EU. Retrobulbar chlorpromazine injections for the management of blind and seeing painful eyes. J Glaucoma. 2002;11(3):209–13.
Skorin L. Treatment of Blind and Seeing Painful Eye. [online] Jan 16 2004 Available from: www.optometry.co.uk
Bietti G. New Trends for the Relief of Glaucoma. JAMA. 1950;142(12):889-97. doi: 10.1001/ jama.1950.02910300027006
Sinha A, Rahman A. Cyclocryotherapy in absolute glaucoma. Indian J Ophthalmol. 1984;32(2):77-80.
Kumar CM, Dowd TC, Hawthorne M, Retrobulbar Alcohol Injection for Orbital Pain Relief Under Difficult Circumstances: A Case Report. Ann Acad Med Singapore. 2006; 35:260-5.
Shah-Dessai SD, Tyers AG, Manners RM. Painfull Blind Eye: Efficacy of Enucleation and Evisceration in Resolving Ocular Pain. Br J Ophthalmol. 2000; 84: 437-8. doi: 10.1136/bjo.84.4.437
Merbs SL. Management of blind painful eye. Ophthalmol Clin North Am. 2006; 19:287-92. doi: 10.1016/j.ohc.2006.02.010
Prost M. Anatomy of the Ciliary Body and Cyclocryotherapy. Ophthalmologica. 1984; 188:9-13. doi: 10.1159/000309338
Zhonghua Yan Ke Za Zhi. Cyclocryotherapy in the treatment of glaucoma.1990 ;26:98-101. PMID:2390906 (in Chinese)
Benson MT, Nelson ME. Cyclocryotherapy: a review of cases over a 10-year period. Br J Ophthalmol. 1990;74:103-5.
Kim BS, Kim YJ, Seo SW, Yoo YM, Kim SJ. Long-term results from cyclocryotherapy applied to the 3 o`clock and 9 o`clock positions in blind refractory glaucoma patients. Korean J Ophthalmol. 2015;29:47-52.
Janicijevic-Petrovic MA, Sarenac T, Petrovic M, Vulovic D, Janicijevic K. Cyclocryotherapy in neovascular glaucoma treatment. Med Glas (Zenica). 2012;9:106-9.
Webber SK, McGhee CN, McMenamin PG. Precautionary note on retrobulbar Alcohol injections. Br J Ophthalmol. 1995; 79(2):192-4.
Cok OU, Eker HE, Cantuerk S, Yaycioelu R, Ariboean A, Arslan G. Pain management in blind, painful eyes: clinical experience with retrobulbar alcohol injection in 4 cases. Agri. 2011; 23(1): 43-6. doi: 10.5505/agri.2011.99705
Akhtar N, Tayyab A, Kausar A, Jaffar S. Pain management with retrobulbar alcohol injection in absolute glaucoma. J Pak Med Assoc. 2015; 65(6):678-80.
Birch M, Strong N, Brittain P, Sandford-Smith J. Retrobulbar phenol injection in blind painful eyes. Ann Ophthalmol. 1993; 25(7):267-70.
Maumenee AE. Retrobulbar alcohol injections: relief in ocular pain in eyes with and without vision. Am J Ophthalmol. 1949;32(11):1502-8. doi: 10.1016/ S0002-9394(49)90370-0
Al-Faran MF, Al-Omar OM. Retrobulbar alcohol injection in blind painful eyes. Ann Ophthalmol. 1990; 22(12):460-2.
Olurin O, Osuntokun O. Complications of retrobulbar alcohol injections. Ann Ophthalmol. 1978;10(4):474-6.
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