选择性激光小梁成形术治疗原发性青光眼的疗效

Curative effects of selective laser trabeculoplasty for primary glaucoma

目的评价选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗原发性开角型青光眼(primary open-angleglaucoma,POAG)和原发性慢性闭角型青光眼(chronic primary angleclosure glaucoma,CPACG)的疗效及安全性。方法收集我院眼科2007年1月至2008年1月就诊的原发性青光眼患者34例61眼,其中POAG组患者18例34眼,CPACG组患者16例27眼,2组均应用SLT治疗。观察患者术后1h、1d、1周、1个月、3个月、6个月的眼压以及术后6个月视力、视野、房角及角膜内皮细胞数等变化。结果2组患者眼压在激光治疗后均有显著下降,POAG组患者术前平均眼压为(25.2±2.2)mmHg(1kPa=7.5mmHg),术后1h、1d、1周、1个月、3个月、6个月眼压分别为(28.9±1.3)mmHg、(17.0±1.9)mmHg、(19.9±1.7)mmHg、(20.1±1.8)mmHg、(18.2±2.1)mmHg、(18.0±2.1)mmHg。CPACG组患者术前平均眼压为(24.9±2.1)mmHg,术后对应时间点眼压分别为(29.3±1.6)mmHg、(16.9±2.0)mmHg、(20.3±1.8)mmHg、(19.3±1.9)mmHg、(20.1±2.0)mmHg、(18.9±2.2)mmHg。2组术后1d、1周、1个月、3个月、6个月的眼压与术前相比明显下降,差异均有统计学意义(P均<0.05)。术后1d眼压下降最明显,术后一过性眼压升高为最常见的并发症。术后6个月2组患者随访视力、前房角、视野、角膜内皮细胞计数与术前比较均无明显变化。结论SLT可以安全有效地降低POAG和房角大部分开放的CPACG患者的眼压。

Objective To evaluate the efficacy and safety of selective laser trabeculoplasty（SLT） in the treatment of primary open-angle glaucoma（POAG） and chronic primary angle-closure glaucoma（CPACG）. Methods SLT was operated in randomly selected 34 primary glaucoma patients （ 61 eyes）, which included 18 POAG patients （34 eyes） and 16 CPACG patients （27 eyes）. The changes of visual acuity,visual field,angle and corneal endothelial cell numbers were observed at 6 months postoperatively. IOP was measured at 1 hour, 1 day, 1 week, 3 months and 6 months postoperatively, respectively. Results IOP decreased significantly in two groups after laser treatment. The mean preoperative IOP was （25.2 ± 2.2） mmHg （ 1 kPa = 7.5 mmHg） in POAG group, and （24.9 ± 2. 1 ） mmHg in CPACG group. The mean IOP at 1 hour, 1 day, 1 week, 3 months and 6 months postoperatively were （ 28.9± 1.3 ） mmHg, （ 17.0 ± 1.9 ） mmHg, （19.9±1.7）mmHg,（20. 1±1.8）mmHg,（18.2±2.1）mmHgand （ 18.0 ±2. 1 ）mmHg, respectively,in POAG group, and were （ 29.3 ± 1.6 ） mmHg （ 16.9 ± 2.0 ） mmHg, （ 20.3 ± 1.8 ） mmHg, （ 19.3 ± 1.9 ） mmHg, （ 20.1 ± 2.0 ） mmHg, （ 18.9 ± 2.2 ） mmHg, respectively, in CPACG group. There were statistically significant decreases in lOP at 1 hour, 1 day, 1 week,3 months and 6 months postoperatively compared with preoperative IOP in the two groups（ all P 〈 0.05 ）. IOP decreased obviously at 1 day postoperatively. Transient high IOP was the most common complication. No significant differences was found about visual acuity, visual field, angle and corneal endothelial cell numbers between pre- and post-operation. Conclusion SLT is a safe and effective method for reducing IOP in POAG patients and CPACG patients with most opened angle.