不同区域选择性激光小梁成形术的降眼压效果观察

Observation on the efficacy of reducing IOP by selective laser trabeculoplasty in different region

目的 观察小梁网不同区域180度选择性激光小梁成形术（SLT）治疗原发性开角型青光眼（POAG）和高眼压症的效果.方法 前瞻性研究,收集者为单眼或双眼POAG或高眼压症共89例（107眼）,随机被分为A、B、C和D组,A组行下方180度SLT,B组行上方180度SLT,C组行鼻侧180度SLT,D组行颞侧180度.分别于术前、术后1周、1、3、6和12个月时测量眼压,并记录SLT的点数和能量.SLT成功率标准为不用任何降眼压药物眼压较基线眼压下降≥20％.结果 基线眼压为22～30 mmHg,平均为（23.8±4.0）mmHg.术后随访12个月,4个组的眼压平均下降分别为（7.1±2.5）mmHg,（6.5±3.3）mmHg,（7.0±3.9）mmHg和（6.4±2.6）mmHg（1 mmHg=0.133 kPa）.成功率分别为46.4％、44.4％、42.3％和42.3％,4个组之间眼压下降程度及成功率差异均无统计学意义.其中A组3眼,B组2眼,C组2眼在SLT后1 h内出现一过性眼压升高,无其他不良反应.结论 小梁网不同区域180度SLT均可有效降低POAG和高眼压症的基线眼压,而且SLT的治疗效果并不受治疗部位的影响.

Objective To observe the efficacy of 180 degree selective laser trabeculoplasty（SLT）in the different trabecular meshwork（TM）area for the treatment of primary open-angle glaucoma（POAG）or ocular hypertension（OHT）.Methods This was a prospective randomized clinical trial study.The data of 107 eyes of 89 patients with unilateral or bilateral POAG and OHT were collected.All patients were randomly divided into group A,B,C,and D.Group A was treated with 180 degree SLT in the lower TM,group B in the upper TM,group C in the nasal TM,and group D in the temporal TM.The IOP was measured before and 1 week,1,3,6 and 12 months after SLT.The shots and energy of SLT at different time points were recorded.SLT success was defined as IOP reduction≥20%from baseline without any IOP-lowering medication.Results The average baseline IOP was（23.8±4.0）mmHg,range 22-30 mmHg（1 mmHg=0.133 kPa）.At the end of the follow-up,12 months after SLT treatment,the mean reduction of IOP in group A,B,C and D were（7.1±2.5）mmHg,（6.5±3.3）mmHg,（7.0±3.9）mmHg and（6.4±2.6）mmHg,and the success rates were 46.4%,44.4%,42.3%and 42.3%,respectively.The difference were not statistically significant in the IOP reduction and success rate of SLT treatment among the four groups.Three eyes in group A,2 eyes in group B and 2 eyes in group C happened transient elevation of IOP within 1 hour after SLT treatment.No other complication occurred.Conclusion IOP reduction can be effectively achieved by 180 degree SLT in the different TM area of the patients with POAG or OHT,and the success rate of SLT seems not to be affected by different area of TM.