内窥镜下睫状体光凝术:概述和亚洲视角(英文)

Endoscopic cyclophotocoagulation:an overview and Asian perspective

青光眼手术治疗方法已被分为睫状体破坏性(减少流入)或滤过性(增加流出)两大类。睫状体破坏性手术传统上用于视力预后差的青光眼以及难治性青光眼如外伤后、无晶状体眼、先天性青光眼和发育性青光眼。自从1992年Uram首次使用内窥镜下睫状体光凝术(endoscopic cyclo-photocoagulation,ECP)以来,短期和长期的转归已经表明ECP的应用前景广阔。本文在PubMed查询、复习有关ECP的英文文献,并与新加坡一所眼科三级医院的有限结果进行比较。文献报告显示出ECP及联合白内障超声乳化术的ECP在治疗小儿及成人严重的、各种病因所致的青光眼方面的安全性和有效性。这在新加坡某眼科三级医院未发表的短期结果中也有报告,与那些已经发表的结果是一致的。已发表的报告和当前的经验证明,可直视目标组织的ECP,通过内窥镜直视将合适的红外波长激光能量应用于目标组织睫状上皮细胞,避免了"盲目"状态下经巩膜睫状体光凝术所引起的并发症。但是引进这项技术存在着显著的经费困难。ECP在控制眼压和减少抗青光眼药物的依赖性方面是安全有效的。广泛接受和使用这一技术仍有待于大规模的随机对照研究。

Surgical treatment of glaucoma has been classified as cyclodestructive （ reducing inflow） or filtering （ increasing outflow）. Cyclodestructive procedures have traditionally been reserved for eyes with poor visual prognoses and refractory glaucomas including post-trauma, aphakia, congenital and developmental glaucoma. Since Uram described the first use of endoscopic cyclophotocoagulation （ECP） in 1992, short and long-term outcomes for ECP have been promising. In the present article, we conduct a Pubmed search and review of published English literature on endoscopic cyclophotocoagulation and comparison with limited results in a single Singapore ophthalmic tertiary hospital. Safety and efficacy of ECP and combined phacoemulsification-ECP procedures in treatment of pediatric and adult glaucomas of various etiologies and severities is reported. Local short-term unpublished results from a single Singapore tertiary ophthalmic service is reported and concurs with previously published results. Published reports and current experience with ECP has demonstrated that ECP with direct visualization of the target tissues avoids the complications associated with blind＇ trans-scleral cyclophotocoagulation by applying optimum energy to target tissue ciliary epithelium with endoscopic visualization and infrared laser wavelength application. Significant financial barriers exist to introducing this service. It is safe and effective in controlling lOP and reducing reliance on anti-glaucoma medications. Widespread acceptance and use of this technique awaits largescale randomized controlled studies.