以个体化透巩膜睫状体光凝为首选术式治疗钝挫伤后青光眼眼压失控的安全性和有效性

Safety and effectiveness of individualized transscleral cyclophotocoagulation as the initial surgical intervention for medically uncontrolled intraocular pressure in glaucoma after blunt trauma

目的探讨个体化透巩膜睫状体光凝作为首选术式治疗顿挫伤后青光眼眼压失控患者的安全性和有效性。方法回顾性分析2014年1月至2018年12月在我院行透巩膜睫状体光凝治疗的钝挫伤后青光眼患者的临床资料。患者在使用局部和全身最大耐受降眼压药物7~14 d后,眼压仍然>35 mmHg。经超声生物显微镜(UBM)和房角镜检查确定房角损伤位置,31例(31只眼)给予个体化睫状体光凝治疗。分析患者的一般资料及治疗情况。结果患者伤后首诊和术后3周的视力构成比无显著差异(P>0.05)。术后3个月时,患者的平均眼压为(22.2±5.0)mmHg,较术前的(46.6±5.6)mmHg显著降低(P<0.05);术后3个月时,有12只眼无需使用降眼压药物,有5只眼仍需3种以上降眼压药物,需要使用2种以上药物的患者例数较术前显著减少(P<0.05);术后3个月时的手术完全成功率为38.7%,相对成功率(联合1、2种药物)为83.9%。患者均未出现影响视功能的严重并发症。结论对于药物治疗眼压失控的外伤性青光眼患者,个体化睫状体光凝术可作为一种首选的非切开性术式,为其他外伤相关并发症的后期处理和视功能康复创造了条件。

Objective To investigate the safety and effectiveness of individualized transscleral cyclophotocoagulation as the initial surgical intervention for medically uncontrolled intraocular pressure in glaucoma after blunt trauma.Methods The clinical data of patients with glaucoma after blunt trauma who underwent transscleral cyclophotocoagulation in our hospital from January 2014 to December 2018 were retrospectively analyzed.The intraocular pressure was still>35 mmHg after 7-14 d of topical and systemic maximum tolerance drugs for lowering intraocular pressure.Ultrasonic biomicroscopy(UBM)and gonioscopy were used to determine the location of chamber angle injury,and 31 cases(31 eyes)were treated with individualized cyclophotocoagulation.The general information and treatment of the patients were analyzed.Results There was no significant difference in the visual acuity composition ratio between the first visit after the injury and 3 weeks after surgery(P>0.05).At 3 months after surgery,the patients'average intraocular pressure was(22.2±5.0)mmHg,which was significantly lower than the preoperative(46.6±5.6)mmHg(P<0.05);at 3 months after surgery,12 eyes did not need to use drugs for lowering intraocular pressure,5 eyes still need more than 3 kinds of drugs for lowering intraocular pressure,and the number of patients who need more than 2 drugs was significantly less than that before surgery(P<0.05);the complete success rate of surgery at 3 months after surgery was 38.7%,and the relative success rate(combined with 1 and 2 drugs)was 83.9%.None of the patients had serious complications affecting visual function.Conclusion For patients with medically uncontrolled intraocular pressure in glaucoma after blunt trauma,individualized cyclophotocoagulation can be used as the initial choice of non incision surgery,which creates conditions for the post-treatment of other trauma related complications and the rehabilitation of visual function.