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 for primary open-angle glaucoma.

目的评价选择性小梁激光成形术（SLT）治疗各类原发性开角性青光眼（POAG）的疗效观察。方法79例（93眼）根据种族的不同（小梁Seheie色素分级）、年龄及眼压情况分为3组，采用国通公司倍频Q-开关。532nmND：YAG激光器，单脉冲，时间为3ns，波长532nm，光斑直径400μm，脉冲能量设置0．4～1．6mJ。术前在盐酸奥布卡因表麻下放置前房角镜，瞄准功能小梁网，选择相应的脉冲能量、象限范围和激光点数进行治疗或重复治疗。术后随访眼压（1h、1d、1周、1个月、3个月、6个月、1年）、眼底及视野。结果3个组79例（93眼）术前1年平均眼压依次为（23．1±6．3）mmHg、（26．52±6．1）mmHg和（29．52±6．1）mmHg；术后1年眼压依次为（12．52±4．3）mmHg、（15．58±4．7）mmHg和（16．65±4．5）mmHg。术前与术后眼压相比有显著下降（P〈0．01）。3个组眼底C／D比，术前为0．50～0．70±0．15～0．13；术后为0．57～0．68±0．16～0．42。视力：术前0．85～0．57±0．32～0．29；术后0．91～0．58±0．30～0．27，两者比较其差异均无统计学意义。结论SLT对各类POAG均有显著降压作用。

Objective To evaluate selective laser trabeculoplasty （SLT） in treating primary open angle glaucoma（POAG） and observation on the therapeutic effect. Methods 79 patients, 93 eyes were divided into 3 groups acording to the different races, medical history, age, lOP. The ELLEX Laser distributed by GT-Medical Company,with double frequency, 532 nm, Nd：YAG, single pulse, pulse width 3ns, spot size 400 μm, pulse energy 0.4-1.6mJ was used. Pre-op： Oxybuprocaine HC1 for topical anesthesia, a gonioscope, aiming at functional trabecular meshwork, selected different pulse energy, quadrant, different spots, and/or retreatment. Post-op： IOP follow-up at 1 hour, 1 day, I week, 1 month, 3 months,6 months. 1 year, retina, visual field, visual acuity. Results comparison on pre-op and post-op lOP, the three groups of 79 patients and 93 eyes, pre-op average lOP was （23. 134 ±6.34） mmHg, （26. 524 ± 6.11 ）mmHg and （29.52±6. 13）mmHg, 1-year post-op IOP was （12.52 ±4.27）mmHg, （15.58 ±4.71）mmHg and （16. 65±4. 48）mmHg, Therefore, the pre-op and post-op lOP has significantly decreased, shows the statistics meaning. Retina C/D ratio and VA： 3grooups C/D ratio pre-op： 0.40-0.50±0. 14-0. 12, O. 50- 0.70 ± 0.15-0.13 and 0.60-0.80 ± 0.24-0.22 ; 1 -year post-op is 0.30-0. 45 ± 0.32-0.14, 0.47-0. 68 ± 0.68-0.27 and 0.57-0. 70±0.16-0.4. VA（ visual acuity） ： pre-op： 1.00-0.85 ±0.33-0.21, 0. 85-0. 57 ± 0.32-0.29 and O. 63-0.41 ± O. 41-0.24 ; 1 -year post-op ： 1.00-0. 90 ± O. 1243.21, 0.91-0. 58 ±O. 30- 0.27 and 0.74-0.50 ±0.45-0.52, the difference shows statistics meaning （P 〈 0. 01 ）. 3 months post-op visual field： there was no significant decrease in 1-year post-op, 6 months post-op visual field： there were 7 patients who had different degrees damage in the Group 3. Condusion With applying SPSS10.0 statistical software, and matching t test. SLT has significant lOP reduction effect to different kinds of POAC.