选择性激光小梁成形术对药物控制不良开角型青光眼的疗效观察

Selective laser trabeculoplasty for poorly controlled primary open angle glaucoma

目的评价选择性激光小梁成形术(SLT)治疗降眼压滴眼液不能理想控制眼压的原发性开角型青光眼(POAG)的有效性和安全性。方法选择局部联合应用降眼压药物眼压控制仍不理想的POAG患者16例32只眼(A组),观察SLT治疗后的眼压变化情况;并与初次诊断POAG,尚未使用过局部降眼压药物点眼,而直接使用SLT治疗的患者13例(26只眼)(B组)比较。结果 A组术前、术后1周及1、3个月平均眼压分别为(24.22±4.75)、(20.57±3.43)、(20.91±3.25)、(21.78±3.75)mm Hg。B组分别为(24.48±4.15)、(17.15±3.44)、(16.32±3.31)、(16.47±3.16)mm Hg。两组较术前差异均有显著性(P<0.05)。A、B两组比较,A组平均眼压及眼压日波动情况均不如B组理想,两组间差异有显著性。结论 SLT可以安全有效地降低POAG的眼压,但对于降眼压药物眼压控制效果不理想的POAG患者的降眼压效果不如未使用过任何其他治疗的POAG患者,这可能与降眼压药物不能理想控制眼压的POAG患者自身的小梁功能不良有关。

Objective To evaluate the effectiveness and safety of selective laser trabeculoplasty（SLT） in treatment for poorly controlled primary open angle glaucoma（POAG）.Methods Sixteen POAG patients（32 eyes） whose intraocular pressure（IOP） was poorly controlled with topical medications received SLT（group A）.Changes in IOP were observed and compared to those in 13 POAG patients（26 eyes） who received SLT as initial treatment without previous use of topical medications（group B）.Results In group A,average IOP decreased from 24.22 ± 4.75 mmHg pre-surgery to 20.57 ± 3.43,20.91 ± 3.25,and 21.78 ± 3.75 mmHg at 1 week,1 month,and 3 months after the surgery,respectively,whereas in group B,the pre-and post-surgery IOP were 24.48 ± 4.15,17.15 ± 3.44,16.32 ± 3.31,and 16.47 ± 3.16 mmHg,accordingly.The difference in IOP between group A and group B was significant（P 0.05）.In addition,IOP fluctuation was significantly larger in group A than in group B.Conclusion SLT is an effective treatment to decrease IOP in POAG patients.Interestingly,the benefit of SLT was relatively less in patients with poorly controlled IOP by topical medications than in patients who received SLT as initial treatment.We speculated that dysfunctional trabecular meshwork might contribute to difficult to control IOP in those patients.