睫状体冷冻及经巩膜二极管激光光凝治疗重症青光眼的疗效分析

Effect of transscleral diode laser cyclophotocoagulation and cyclocryosurgery in treatment of severe glaucoma

目的:比较睫状体冷冻及经巩膜二极管激光光凝治疗重症青光眼的效果。方法:收集我院2006-08/2007-10重症青光眼患者72例(72眼),用睫状体冷冻及半导体二极管激光治疗,随机分为两组,睫状体冷冻组36例(36眼),于角巩膜缘后2mm区域360°用液态二氧化碳冷冻机行睫状体冷冻,共6～8点,60～120s/点。睫状体光凝组36例(36眼),于角巩膜缘后1.5mm行全周睫状体光凝,激光点数16～36点,能量1.4～2.0W,脉冲时间0.5～2s。结果:对睫状体冷冻组及睫状体光凝组进行术后观察1,7d;1,3,6mo后分析比较,术后短期内:眼压降低、术后渗出反应及疼痛等指征有显著差异(P<0.05),远期各项比较无显著差异。结论:两组方法对于治疗重症青光眼,控制眼压,缓解疼痛均有显著疗效,睫状体光凝能量确切,操作简便安全,术后眼压下降迅速,对眼睑、结膜及巩膜等影响小,眼球萎缩及光感消失等发生几率低,而睫状体冷冻对于角膜变性、角巩膜葡萄肿及先天性大眼球等激光定位困难且易穿孔者有优势。

AIM： To compare the effect of diode laser transscleral cyclophotocoagulation （DL Tscpc） with cyclocryosurgery for severe glaucoma. METHODS： A total of 72 cases （72 eyes） with severe glaucoma were randomly divided into two groups. Group A （36 eyes） was treated by cyclocryosurgery using liquid carbon dioxid＇e freezer with 6-8 spots and 60-120 seconds of every spot behind 2mm of corneoscleral limbus of all around. Group B （36 eyes） was treated by DL Tscpc with energy power of 1.4-2.0W and laser spots of 16-36 and the pulse time of 0. 5-2, 0 seconds behind 1. 5mm of corneoscleral limbus of all around. Intraocular pressure （IOP）, visual acuity, ocular pain symptoms and complications were observed after cyclocryosurgery and DL Tscpc. RESULTS： After 1, 7 days, 1, 3 and 6 months of follo- wed up, the results showed that the ohort-term IOP between two groups had significant deviation （P〈 0.05）, but the long-term IOP had no statistical significance （P〉0.05）. CONCLUSION： These two methods make effect in treatment of severe glaucoma including controlling IOP and relieving pain of eyes. It is concluded that DL TScpc is a simple, safe and effective therapy for eyes with severe glaucoma, but cyclocryosurgery has other fortes Jn treatment of corneal degeneration, corneoscleral staph- yloma and inborn macrophthalmia.