微脉冲激光小梁成形术治疗开角型青光眼及高眼压症的疗效及安全性

The efficiency of micropulse laser trabeculoplasty for open angle glaucoma and ocular hypertension patients

目的研究微脉冲激光小梁成形术(MLT)治疗开角型青光眼及高眼压症的安全性和有效性。方法采用前瞻性自身对照研究设计。连续收集2016年6月至2017年6月于北京大学第三医院眼科就诊的开角型青光眼及高眼压症患者共56例56眼,其中男32例,女24例;年龄(50.4±19.0)岁;原发性开角型青光眼48例,正常眼压性青光眼3例,高眼压症5例。MLT治疗前视力为0.7±0.3,眼压为(20.4±5.8)mmHg(1 mmHg=0.133 kPa),使用抗青光眼药物的数量平均为1.7种,包括全身用药和局部用药。每例患者任意选择一眼,采用微脉冲激光治疗仪进行MLT治疗,治疗后2 h、1 d、1周、1个月和3个月进行复查,记录患者的视力眼压、不良反应和用药情况。结果治疗后2 h、1 d、1周、1个月和3个月眼压分别为(20.2±6.7)、(17.6±4.4)、(18.1±4.5)、(17.4±3.4)和(17.0±2.1)mmHg治疗前后不同时间点眼压总体比较,差异有统计学意义(F=7.320,P<0.001)。治疗后1 d、1周、1个月、3个月眼压均较治疗前明显降低,差异均有统计学意义(均P<0.05)。MLT治疗后3个月,使用抗青光眼药物的数量平均为1.5种,均为局部用药。所有患者未见感染、前房积血、角膜损伤、组织灼伤等并发症。结论MLT可以安全、有效地降低开角型青光眼和高眼压症患者的眼压,并减少青光眼药物的使用。

Objective To evaluate the efficiency and safety of micropulse laser trabeculoplasty(MLT)for open angle glaucoma(OAG)patients and ocular hypertension(OHT)patients.Methods A prospective self-controlled study was designed.Fifty-six eyes of 56 OAG and OHT patients in Peking University Third Hospital were recruited from June 2016 to June 2017,including 32 males and 24 females with the age of(50.4±19.0)years old.The diagnosis included 48 eyes of primary open angle glaucoma(POAG),3 eyes of normal tension glaucoma and 5 eyes of OHT.The best corrected vision acuity(BCVA)was 0.7±0.3 before treatment.The intraocular pressure(IOP)before MLT was(20.4±5.8)mmHg,the average types of antiglaucoma medications was 1.7,including systemic medication and local drug use.The general information,BCVA,IOP and antiglaucoma medication were recorded.Only one eye of each patient was treated by MLT.The IOP at different follow-up time points(2 hours,1 day,1 week,1 month,3 months post-treatment)and the number of antiglaucoma medication before and after treatment were compared.This study protocol was approved by Ethic Committee of Peking University Third Hospital(No.2014166).Written informed consent was obtained from each subject prior to any medical examination.Results The IOP after MLT was(20.2±6.7),(17.6±4.4),(18.1±4.5),(17.4±3.4)and(17.0±2.1)mmHg at 2 hours,1 day,1 week,1 month and 3 months,respectively,with significant difference among the different time points(F=7.320,P<0.001).Compared with the IOP before treatment,the IOP at 1 day,1 week,1 month and 3 months after treatment were significantly decerased,with significant differences between them(all at P<0.05).Three months after treatment,the average number of glaucoma medications used was 1.5,and only local administration was used.Infection,hyphema,cornea injury,burns and other complications were not seen in all the patients.Conclusions MLT is effective and safety for OAG and OHT patients,and reduce the use of glaucoma drugs.