选择性激光小梁成形术治疗原发性青光眼

Selective laser trabeculoplasty on primary open-angle glaucoma and primary angle-closure glaucoma with previous iridotomy

目的评价选择性激光小梁成形术治疗原发性开角型青光眼(primaryopenangleglaucome,POAG)及原发性闭角型青光眼(prionaryangleclosureglaucome,PACG)虹膜周切术后残余青光眼的疗效和安全性。方法前瞻性、非随机性选择局部用药眼压不能控制的原发性开角型青光眼患者(13例16眼),或已行周边虹膜切除或激光虹膜打孔术,房角大部开放而眼压高的原发性闭角型青光眼患者(22例32眼)。应用选择性激光小梁成形术治疗。观察患者术后6个月眼压的变化。结果两组患者的眼压在激光治疗后均有显著下降:POAG组由术前的(25.3±3.9)mmHg降低至术后6个月的(18.0±4.2)mmHg;PACG组由术前的(23.9±3.0)mmHg,降低至术后6个月的(18.8±3.8)mmHg(1kPa=7.5mmHg)。术后暂时的眼压升高为最常见的并发症。结论选择性激光小梁成形术不仅可用于原发性开角型青光眼的治疗,也可以作为治疗残余闭角型青光眼的一种安全有效的方法。

Objective To study the effectiveness and safety of selective laser trabeculoplasty （SLT） on primary open-angle glaucoma （POAG） and primary angle-closure glaucoma （PACG） with previous iridotomy.Methods A prospective non-randomized clinical trial was designed. POAG patients with IOP 〉 21 mmHg in spite of topical antiglaucoma treatment or PACG patients with uncontrolled intraocular pressure（IOP） in spite af previous iridotomy and opened angle were enrolled, Q-switched 532-nm Nd： YAG liner was used. Pallets were evaluated after laser treatment at 2 h, 1 day, 1 week, weeks, 1 month, 3 month, 6 month. Results 32 eyes of 22 patients with PACG and 16 eyes of 13 patients with POAG were included in this study. The mean IOP was（23.9±3.0） mmHg in PACG group and （25.3±3.9）mmHg in POAG group. The mean IOP reduction was （5.0±2.3）mmHg （P〈0.05） in PACG group and （7.0±3.3）mmHg （P 〈0.05） in POAG group at the six month follow-up visit （1 kPa - 7.5 mmHg）. The mean laser energy used per treatment was （93.7±41.2）mJ in PACG group, and （93.3±21.0）mJ in POAG group, respectively. A transient increase of IOP was the most common complication after the procedure. Patients with IOP increasing mace than 8 mmHg was about 19% one hour after liner treatment. Conclusion The selective laser trabeculoplasty is not only a good choice for POAG, but also appears to be a safe and effective method to lowex IOP in PACG with previous iridotomy.