经巩膜睫状体光凝术治疗难治性青光眼的效果

The efficacy of transscleral cyclophotocoagulation for refractory glaucoma

目的评价经巩膜睫状体光凝术(TCP)治疗难治性青光眼的效果。方法回顾性研究。对北京爱尔英智眼科医院2017年7月至2018年12月行TCP治疗的难治性青光眼73例(81只眼)的临床资料进行分析。观察手术前后眼压、降眼压药物使用种类、术中光凝情况和并发症的发生。术后随访6个月。结果术前眼压(35.0±8.8)mmHg(1mmHg=0.133 kPa);术前使用降眼压药物3(3,4)种;术中光凝能量(2027.00±235.88)mW、光凝范围238.0°±44.7°、光凝点数(31.00±7.17)个;术后1 d眼压为(18.67±7.13)mmHg,术后1个月眼压(18.50±8.28)mmHg,术后3个月眼压(19.25±6.79)mmHg,术前与术后各时间点眼压差异均有统计学意义(t=14.496、12.775、11.277、11.802,均P<0.05);术后使用降眼压药物0(0,1)种;术后视力不变65只眼(80.2%);各类型难治性青光眼手术成功率70.0%~87.5%;术后长期低眼压2只眼,眼球萎缩2只眼。结论TCP可有效治疗难治性青光眼,对继发性青光眼效果优于原发性青光眼。

Objective To evaluate the efficacy of transscleral cyclophotocoagulation(TCP)for the treatment of refractory glaucoma.Methods This was a retrospective study.The clinical data of 81 eyes of 73 cases with refractory glaucoma who underwent TCP treatment from Jul.2017 to Dec.2018 in Beijing Aier-Intech Eye Hospital were analyzed.The preoperative and postoperative IOP,kinds of anti-IOP drugs,intraoperative photocoagulation and occurrence of complications were observed.The follow-up time was 6 months after operation.Results The intraocular pressure was(35.0±8.8)mmHg before operation(1 mmHg=0.133 kPa).The preoperative kinds of anti-IOP drugs was 3(3,4)kinds.The photocoagulation energy was(2027.00±235.88)mW and the cyclophotocoagulation range was 238.0°±44.7°.The number of cyclophotocoagulation points was 31.00±7.17.The intraocular pressure was 6-38 mmHg at 1 day postoperatively,with an average of(18.67±7.13)mmHg.The intraocular pressure was(18.50±8.28)mmHg at 1 month after operation,and the intraocular pressure was(19.25±6.79)mmHg at 3 months after operation.The difference between preoperative and postoperative intraocular pressure at each time point was statistically significant(t=14.496,12.775,11.277,11.802;all P<0.05).The postoperative kinds of anti-IOP drugs was 0(0,1)kinds.The postoperative visual acuity was unchanged in 65 eyes(80.2%).The successful rate of all types of refractory glaucoma was 70.0%to 87.5%.Complications included 2 eyes of long-term low intraocular pressure and 2 eyes of postoperative eyeball atrophy.Conclusion TCP is effective for the treatment of refractory glaucoma.The efficacy of the secondary glaucoma is better than that of the primary glaucoma.