眼内窥镜下激光睫状体光凝术治疗难治性青光眼的疗效评价

The clinical study of endoscopic cyclophotocoagulation on the management of refractory glaucoma

目的探讨眼内窥镜下激光睫状体光凝术（endoscopic cyclophotocoagulation, ECP）治疗难治性青光眼的疗效和安全性.方法采用Endo Optiks URAM-E2激光内窥镜系统对47例（51只眼）难治性青光眼患者进行ECP治疗（有4只眼接受2次治疗）,观察患者术后眼压变化、视力及并发症情况,术后分别随访6～16个月,平均10.8个月.结果 51只眼术前用药情况下眼压平均为（35.3±13.0）mm Hg（1 mm Hg＝0.133 kPa）,术后1周眼压平均为（19.9±13.2）mm Hg,术后1个月眼压平均为（22.0±11.6）mm Hg,术后3个月眼压平均为（17.6±11.6）mm Hg,术后6个月眼压平均为（17.0±10.4） mm Hg,术前、后眼压差异有统计学意义（P〈0.01）.术前平均使用降眼压药物3.3种,术后下降至1.0种,差异有统计学意义（P〈0.01）.术后无需应用药物治疗,而眼压≤21 mm Hg者26只眼,占51.0%;应用局部药物治疗情况下,眼压≤21 mm Hg者13只眼,占25.5%.患者术后视力较术前增高,差异有统计学意义（P〈0.01）.51只眼中,有4只眼术后出现少量前房积血,分别于术后2～5 d吸收;有23只眼术后瞳孔区出现纤维素样渗出,加强抗感染治疗后均在1周内吸收;2只眼术后发生渗出性脉络膜脱离,分别于7、16 d复位.所有患者术后均未出现人工晶状体偏位或脱位、眼压过低、视网膜脱离、脉络膜上腔出血、眼内炎或交感性眼炎等并发症.结论 ECP能有效地降低难治性青光眼的眼压,手术操作简单,无明显严重并发症.ECP是治疗难治性青光眼的安全而有效的手术方法之一.

Objective To evaluate the efficacy and safety of endoscopic cyclophotocoagulation （ECP） in the management of refractory glaucoma. Methods ECP procedures were performed on fifty-one eyes of 47 patients with refractory glaucoma by using the Microprobe （ Endo Optiks, URAM E2 ） integrated laser endoscope system. All patients were followed-up from 6 to 16 months （mean 10. 8 months）, with four eyes receiving a second treatment. The changes of intraocular pressure （IOP）, visual acuity and complication were pre- and post-operatively observed. Results Compared to preoperation, the IOP of postoperation was significantly （ P 〈 0.01 ） decreased at week 1, 4, 12, and 24 [ （ 35. 3 ± 13.0 ） mm Hg （1 mm Hg=0.133 kPa）vs（19.9 ±13.2）mm Hg,（22.0±11.6）mm Hg,（17.6±11.6）mm Hg, and （ 17.0 ± 10. 4 ） mm Hg,x^- ± s, respectively ]. The mean number of IOP-decreased drugs used was significantly （ P 〈 0. 01 ） reduced from 3. 3 to 1.0 of postoperation. 51.0% of all 51 eyes with the postoperative IOP less than 21 mm Hg did not receive any drug, and 25.5% with supplemental drug treatment. The visual acuity was significantly（ P 〈0. 01 ）improved postoperatively. Postoperative hyphema were found in 4 eyes, fibrous exudates in 23 eyes, and exudative choroids detachment in 2 eyes, all of which occurred at the early postoperative stage and were healed within 2-16 days. No other complications were observed. Conclusion ECP is a safe and effective procedure for the management of refractory glaucoma without serious complications.