半导体激光经巩膜睫状体光凝治疗晚期难治性青光眼

TRANSSCLERAL DIODE LASER CYCLOPHOTOCOAGULATION FOR TREATMENT OF REFRACTORY GLAUCOMA

目的 :观察半导体激光经巩膜睫状体光凝治疗晚期难治性青光眼的效果。方法 :对 4 3例 (46只眼 )晚期难治性青光眼施行半导体激光经巩膜睫状体光凝术。术前眼压 4 5 7～ 14 5 3kPa ,平均 (8 4 1±2 12 )kPa。 10～ 80岁 ,平均 5 3 4岁。术前视力 :30只眼为无光感 ,另 16只眼为光感～ 0 0 4。激光参数 :功率 1 5～ 2 0W ,时间 2s ,在 36 0°范围击射 2 0～ 4 9点 ,术后追踪随访 ,记录症状、眼压、视力及并发症。结果 :手术性眼痛反应轻 ,持续 2～ 3h。术后第 1天眼压降低 2 6 %～ 80 % ,平均 5 2 % ,术后 14～ 30d达最低值 ,14d以后有 70 %以上的眼压在 0 6 7～ 2 80kPa。有 6只眼因术后眼压仍高于 5 33kPa需重复治疗 ,其中 5只眼是新生血管性青光眼。术后眼痛缓解率为 10 0 %。并发症主要有虹膜睫状体炎和前房积血。结论 :半导体激光睫状体光凝降眼压效果快 ,眼压控制率和眼痛缓解率高 ,可作为晚期难治性青光眼的首选治疗方法 ,但对尚存一定视功能的患者应慎用。

Objective:To evaluate the effect of transscleral diode laser cyclophotocoagulation(TDLC) for treatment of refractory glaucoma.Methods:43 cases (46 eyes) of late stage refractory glaucoma were treated with TDLC.Preoperative intaocular pressure(IOP) ranged from 4.57 to 14.53 kPa,mean (8.41±2.12) kPa.Age ranged from 10 to 80,averaging 53.4 years old.Preoperative visual acuity(VA):no light perception in 30 eyes,light perception to 0.04 in 16 eyes.Parameters of laser treatment:1.5 to 2.0W power,2s exposure,and 20 to 49 shots in 360° range.Symptoms,IOP,VA and complications were followed up and documented.Results:Minimal to mild pain due to treatment persisted for 2 to 3 hours.Marked decrease of IOP of 26% to 80%,averaging 52%,was observed first day postoperatively,comparing to preoperative IOP.IOP was lowest in 2 weeks to 1 month.Two weeks after treatment,IOP of 0.67 to 2.80 kPa were recorded in 70% and over treated eyes.Treatment was repeated in 6 eyes for IOP over 5.33kPa,among which 5 eyes were neovascular glaucoma.Pain was relieved in 100% of the treated eyes postoperatively.Main complications were iridocyclitis and hyphema.Conclusion:TDLC quickly decreases IOP.The control rate of pain and IOP is high.It can be the treatment of choice for late stage refractory glaucoma,yet it should be conducted with care for patients with vision to some extent.