内窥镜下睫状体光凝术与经巩膜睫状体光凝术治疗难治性青光眼的临床对比研究

The clinical effect of endoscopic cyclophotocoagulation in the treatment of refractory glaucoma contrast with trans-sleral eyclophotocoagulation

目的探讨内窥镜下激光睫状体光凝术(Endoscopic cyclophotocoagulation,ECP)和经巩膜睫状体光凝术(Trans-scleral cyclophotocoagulation,TSCP)治疗难治性青光眼的效果和安全性。方法回顾性分析睫状体光凝术治疗的难治性青光眼 95 例(101 只眼),按其激光能量到达睫状体的方式分别为内窥镜下组(ECP 组)和经巩膜组(TSCP 组)。观察研究两组术中所用的激光能量,手术后眼压、视力的改变以及术中术后的并发症等,对比研究两种手术方式的治疗效果和安全性。结果ECP 组所用激光能量为0.35～1.0W,曝光时间为0.5～1.0s,明显低于TSCP 组的1.6～2.7W,1.0～2.0s。ECP组的光凝范围为:(185.88 ±58.01)°,TSCP 组为(180 ±90)°,两组的光凝范围无明显差异(P>0.05)。两组术后最后复诊时眼压下降幅度比较,具有显著性差异(t=6.021,P<0.001),ECP 组的眼压下降幅度大于 TSCP 组。ECP 术后6 个月有39 只眼的眼压控制在 21mmHg 以下,成功率为76.5%。TSCP术后6个月有31只眼的眼压控制在21mmHg以下,成功率为62.00%,两者差异无统计学意义:术后12个月时两组的成功率分别为66.67%、48.00%,差异有统计学意义(P=0.045)。术后ECP 组的视力恢复比TSCP 组好(P=0.003)。ECP组的主要并发症为纤维素样前房渗出、反应性高眼压、前房积血和渗出性脉络膜脱离,后期未见人工晶体偏位或脱位、眼压过低、持续性低眼压、视网膜脱离、眼内炎或交感性眼炎。TSCP 组的并发症主要有球结膜充血和水肿、明显的眼前段炎症、术后早期反应性高眼压和前房积血。术后中远期的并发症有巩膜葡萄肿和持续性低眼压。结论与TSCP比较,ECP 能更有效地降低难治性青光眼的眼压,手术操作简单,无明显术后严重并发症。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） and trans-scleral cyclophotocoagulaiton（TSCP） in the management of refractory glaucoma. Methods A retrospective study of 95 cases （ 101 eyes） refractory glaucoma underwent cyclophotocoagulation.All of the patients were divided into two groups by the operative modes（endoscopic cyclophotocoagulation, ECP or trans-scleral cyclophotocoagulation,TSCP）. The operative energy of laser, changes of intraocular pressure（IOP）,visual acuity and complications were observed and statistical analysis was done to study the therapeutic efficacy and safety. Results The energy of laser in ECP ranged 0.35-0.6W and the exposure time was 0.5-1.0s.Both were lower than those in TSCP（1.6-2.7W, 1.0-2.0s）. The photocoagulation scope in ECP was （185.88 ±58.10）° , and in TSCP was （180 ±90）° . The difference of the photocoagulation scope was not singifficant statistic（P〉 0.05）. The amplitudes of lOP decrease in different groups were significant difference（t=6.021 ,P〈0.001 ）.Which in ECP group was better than TSCP group. Thirty-nine of 51 （76.5%） cases in ECP group succeed in controlling the IOP（ ≤ 21mmHg）at 6 months postoperatively, but TSCP group,there were 62.00%,and there was not signifi-cant difference beteen them; The achievement ratio was 66.67% in ECP group and 48.00% in TSCP group at 12 months postoperatively,and there was statistical significance（P=0.045）.The visual acuity was improved postoperatively（P=0.003）. Postoperative complications in ECP included hyphema, fibrous exudates, incresing intraocular pressure and exudative choroids detachment.All the complications occurred at the early postoperative stage, and were healed soon.None of retinal detachment,hypotony,phthisis,endophthalmitis,or sympathetic ophthalmia was observed.Main complications in TSCP group were bulbar conjunctival congestion and edema, iribocyclitis, incresing intraocular pressure, hyphema. Complications in long-term were scleral staphyloma and atrophia bulbi. Conclusions Contrast with TSCP, ECP is a safe and effective procedure for the management of refractory glaucomas,which can decrease the lOP of refractory glaucomas without any serious complications.