透巩膜睫状体光凝术治疗难治性青光眼疗效观察及其量效关系分析

Transscleral cyclophotocoagulation procedure in refractory glaucoma and dose-response relationship

目的评估透巩膜睫状体光凝术(TCP)治疗难治性青光眼的效果,并探讨其量效关系。方法回顾分析2017年1月~2019年1月眼科接受TCP治疗的难治性青光眼31例(31眼),术后随访6~36个月。结果TCP术后,所有患者眼部疼痛均得到缓解。术后1周,除1例术前术眼角膜大量新生血管化的患者,其余30例患者术眼角膜均恢复透明。至随访结束时,所有患者眼压5~38 mmHg(平均17.93±8.00 mmHg)。TCP术后早期的不良反应包括结膜灼伤,前房积血及轻微的前房炎症反应,晚期不良反应主要为眼球萎缩及角膜葡萄肿。术后眼压与治疗光凝点数成中度负相关,r=-0.41(t=2.05,P<0.05),线性回归方Y=27.53-0.62X(独立变量X为光凝点数,应变量Y为眼压)。术后眼压与光爆点数呈中度负相关,r=-0.58(t=3.75,P<0.01),线性回归方程为Y=28.39-1.26X(独立变量X为光爆点数,应变量Y为眼压)。结论TCP是一种简单、安全、有效的难治性青光眼的治疗方式。推荐的治疗剂量为光凝点数15左右或8个左右光爆点数。

Objective To investigate the efficiency of transscleral cyclophotocoagulation(TCP)in refractory glaucoma and to evaluate the dose-response relationship.Methods A retrospective analysis of the cases of 31 eyes of 31 consecutive patients with uncontrolled glaucoma who underwent TCP.Six to thirty-six months were reviewed.Results All the 31 patients felt a relieved ocular pain after TCP.Corneas of 30 eyes turned to transparent one week after TCP,except one eye with corneal epithelialization.IOP of all patients decreased to 5~38 mmHg(average is 17.93±8.00 mmHg)at the end of the follow-up.The main earlier complications of TCP include conjunctival burns,hyphema and mild inflammation of the anterior chamber,and the late complications were phthisis bulbi and corneal staphyloma.IOP was moderately negative related to the number of spots,r=-0.41(t=2.05,P<0.05),and the linear regression equation is Y=27.53-0.62X(independent variable X represents the number of spots,dependent variable Y represents the IOP).To a medium extent,the IOP was negatively correlated with the number of the audible spots,r=-0.58(t=3.75,P<0.01),and the linear regression equation is Y=28.39-1.26X.Conclusion Cyclophotocoagulation is an easy,safe and effective procedure in refractory glaucoma.The recommended parameter is about 15 spots or 8 audible spots.