选择性激光小梁成形术治疗原发性开角型青光眼

Selective laser trabeculoplasty in the treatment of primary open-angle glaucoma

目的研究选择性激光小梁成形术(SLT)治疗原发性开角型青光眼的有效性和安全性。方法前瞻性非随机临床研究,对63例(85眼)药物控制眼压不良的原发性开角型青光眼患者行 SLT 治疗,采用532 nm 波长、Q 开关、Nd:YAG 激光在下方180°范围的小梁网上做(50±5)个相邻但不重叠的激光斑,能量0.6～1.8 mJ。治疗前后,抗青光眼药物使用保持不变。所有患者治疗前和治疗后1 h、2 h、1 d、7 d、14 d、1个月、2个月、3个月、6个月、9个月、12个月、18个月、24个月进行眼部检查。结果 SLT 治疗前平均眼压为(25±4)mm Hg(1 mm Hg=0.133 kPa),与基线值相比,治疗后1 d平均眼压下降8.1 mm Hg(32.0%),7 d 下降5.6 mm Hg(22.1%),14 d 下降4.7 mm Hg(18.6%),1个月下降5.5 mm Hg(21.7%),2个月下降5.1 mm Hg(20.2%),3个月下降5.9 mm Hg(23.3%),6个月下降5.2 mm Hg(20.6%),9个月下降4.0 mm Hg(15.8%),12个月下降4.2 mm Hg(16.6%),18个月下降3.8 mm Hg(15.0%),24个月下降3.3 mm Hg(13.O%)(P<0.01或0.05)。不良反应轻微,包括结膜充血、轻度前房反应和短暂眼压升高。结论 SLT 可以有效、安全地降低原发性开角型青光眼患者的眼压。

Objective To investigate the efficacy and safety of selective laser trabeculoplasty （SLT） in the treatment of primary open angle glaucoma （POAG）.Methods In a prospective nonrandomized clinical study, 63 patients （85 eyes） with POAG and medically uncontrolled intraocular pressure （IOP） underwent SLT. A total of 50 ±5 adjacent but nonoverlapping spots were placed over inferior 180° of the trabecular meshwork using a 532 nm, Q-switched, Nd： YAG laser at energy levels ranging from 0.6 - 1.8 mJ per pulse. After SLT, the eyes continued to receive the identical drug regimen. All patients were observed before and 1,2 hours, 1, 7 and 14 days, and 1, 2, 3, 6, 9, 12, 18, and 24 months after the treatment. Results The average pre-operative IOP was （25 ± 4） mm Hg（1 mm Hg =0. 133 kPa）. The mean IOP reduction from baseline were 8. 1 mm Hg （32. 0% ） 1 day after the SLT , 5.6 mm Hg （22. 1% ） 7 days after the SLT, 4. 7 mm Hg （ 18.6% ） 14 days after the SLT, 5.5 mm Hg （21.7%） 1 month after the SLT, 5. 1 mm Hg （20. 2% ） 2 months after the SLT, 5. 9 mm Hg （23.3%） 3 months after the SLT, 5.2 ram Hg （20. 6% ） 6 months after the SLT, 4. 0 mm Hg （ 15. 8% ） 9 months after the SLT, 4. 2 mm Hg （16.6%） 12 months after the SLT, 3.8 mm Hg （15.0%） 18 months after the SLT, and 3.3 ram Hg （ 13.0% ） 24 months after the SLT （ P 〈 0. 01 or 0. 05 ）. Adverse reactions were minimal, including conjunctival injection, mild anterior chamber reaction, and transient pressure spike. Conclusion SLT is a safe, and effective method of reducing IOP in POAG patients.