经巩膜睫状体光凝术作为某些闭角型青光眼首选手术方式的研究

Transscleral cyclophotocoagulation( TDCP) as primary surgical intervention in some angle-closure glaucoma

目的探讨将经巩膜二极管激光睫状体光凝术(TDCP)作为某些闭角型青光眼首选手术方式的效果及利弊。方法回顾性病例分析。收集我院眼科住院治疗的闭角型青光眼例99例(103只眼)。患者既往无眼部手术史,以二极管激光经巩膜睫状体光凝术作为降眼压的首选手术方式。分析将睫状体光凝术作为首选手术方式的原因,术后随访眼压、视力、记录术中术后并发症以及后续治疗情况。结果将睫状体光凝术作为首选手术方式的主要原因是术前眼压控制不良,其中67例(69只眼)为原发性急性闭角型青光眼持续性高眼压,22例(24只眼)为原发性慢性闭角型青光眼,其余10例(10只眼)为继发性闭角型青光眼。光凝前眼压(49. 1±12. 4) mm Hg,光凝后1周时(14. 7±7. 0) mm Hg,末次随访时(21. 0±13. 1) mm Hg,眼压变化差异有显著统计学意义(F=276. 027,P<0. 001)。光凝前后不同时间点视力变化眼数分布的比较差异无统计学意义(χ2=5. 927,P=0. 821)。1例光凝后发生眼球萎缩。12例光凝后再行降眼压手术,占11. 8%。结论经巩膜睫状体光凝术对于眼压控制不良的闭角型青光眼,可作为首选手术方式,降眼压效果确切且对视力影响小,并发症少,安全可靠。

Objective To evaluate the efficacy of transscleral diode laser cyclophotocoagulation （TDCP） as primary surgical intervention in some angle-closure glaucoma. Methods 103 eyes of 99 patients with angle-closure glaucoma were retrospectively analyzed, all of which denied previous eye surgery. The reasons for choosing ciliary body photocoagulation as the preferred surgical method were analyzed, IOP, vision, complications during and after the operation were followed up and recorded. Results The main reason of TDCP were applied as the primary surgical intervention was the poor control of IOP. There were 69 eyes of 67 cases with primary acute angle-closure glaucoma （PAACG） and 24 eyes of 22 cases with primary chronic angle-closure glaucoma （PCACG）. The remaining 10 eyes of 10 cases suffered from secondary glaucoma. IOP was 49.1±12.4 mmHg before TDCP, 14.7±7.0 mmHg 1 week after TDCP, 21.0±13.1mmHg at the last follow-up. There were significant differences in IOP among three time-points （ F =276.027, P 〈0.001）.There was no statistically significant difference in the eye number of visual changes among three time-points （χ 2=5.927,P P 0.821）. Eyeball atrophy occurred in one eye after TDCP. The operation of reduced intraocular pressure after photocoagulation was performed in 12 cases （11.8%）. Conclusions TDCP as primary surgical intervention has curative effect in treatment of angle-closure glaucoma when IOP was hard to control, it degrades the IOP definitely, has slight influence to VA and results few complications.