532 nm激光治疗倒睫的临床体会

Clinical experience of 532 nm laser treatment of trichiasis

目的探讨532 nm激光治疗倒睫的临床效果。方法倒睫患者55例(60眼),采用随机数字表分为A组(28例,30眼)及B组(27例,30眼)。均采用532 nm激光进行治疗。两组第1次治疗后复发患者遂行第2次治疗,再复发者行第3次治疗。A组第1次治疗时功率为200~250 mW,复发倒睫第2~3次治疗时功率为250~300 mW。B组第1次治疗时功率为300~350 mW,复发倒睫第2~3次治疗时功率为350~400 mW。比较两组患者术中配合度,术中疼痛度,临床疗效,术后不良反应发生情况。结果A组第1次激光治疗时配合度高于B组,差异具有统计学意义(P<0.05)。两组复发患者第2~3次激光治疗时配合度比较,差异无统计学意义(P>0.05)。A组第1次激光治疗时视觉模拟评分法(VAS)评分低于B组(27例),差异具有统计学意义(P<0.05)。A组复发患者第2~3次激光治疗时VAS评分低于B组(6例),差异具有统计学意义(P<0.05)。术后2周,1、3、6个月进行复诊。A组28例(158根),第1次配合治疗28例(158根),第1次激光术后治愈率为75.9%(120/158);复发8例(38根),复发率为24.1%,配合治疗8例(38根)再次行第2~3次治疗,治愈20根,总治愈率为88.6%,总复发率为11.4%。B组27例(164根),第1次配合治疗23例(139根),第1次激光术后治愈率为75.6%(124/164);复发6例(15根)复发率为10.8%,配合治疗5例(12根)再次行第2~3次治疗,治愈3根,总治愈率为77.4%,总复发率为6.5%。两组第1次激光术后治愈率比较,差异无统计学意义(P>0.05)。A组第1次激光术后复发率高于B组,差异具有统计学意义(P<0.05)。A组总治愈率高于B组,差异具有统计学意义(P<0.05)。两组总复发率比较,差异无统计学意义(P>0.05)。两组患者术后均未发生睑缘畸形及任何瘢痕,且术后视力无影响。结论532 nm激光治疗倒睫是一种简便、精准、快速及微创的治疗方式。功率大小运用不同,其治愈率及复发率不同。可根据患者具体情况选择个性化治疗方案。

Objective To discuss the clinical effect of 532 nm laser in the treatment of trichiasis.Methods A total of 55 patients(60 eyes)with trichiasis were randomly divided into group A(28 cases,30 eyes)and group B(27 cases,30 eyes)by random numerical table.All patients were treated with 532 nm laser.After the first treatment in the two groups,the patients who relapsed received the second treatment,and those who relapsed received the third treatment.In group A,the power was 200-250 mW at the 1st treatment and 250-300 mW at the 2nd-3rd treatments for recurrent trichiasis;in group B,the power was 300~350 mW at the 1st treatment and 350-400 mW at the 2nd-3rd treatment for recurrent trichiasis.The intraoperative cooperation,intraoperative pain,clinical efficacy,and the occurrence of postoperative adverse effects were compared between the two groups.Results The degree of cooperation at the first laser treatment in group A was higher than that in group B,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the degree of cooperation between the two groups at the 2nd-3rd treatments(P>0.05).The visual analogue scale(VAS)score of group A was lower than that of group B(27 cases)at the first laser treatment,and the difference was statistically significant(P<0.05).The VAS score of the recurrence patients in group A was lower than that in group B(6 cases)at the 2nd-3rd treatments,and the difference was statistically significant(P<0.05).Followup visits were performed at 2 weeks,1,3,and 6 months after the surgery.There were 28 cases(158 eyelashes)in group A,28 cases(158 eyelashes)were treated for the first time,and the cure rate after the first laser surgery was 75.9%(120/158);8 cases(38 eyelashes)recurred,and the recurrence rate was 24.1%;8 cases(38 eyelashes)received 2nd-3rd treatments,and 20 eyelashes were cured,with a total cure rate of 88.6%and a total recurrence rate of 11.4%.There were 27 cases(164 eyelashes)in group B,23 cases(139 eyelashes)were treated for the first time,and the cure rate after the first laser surgery was 75.6%(124/164);6 cases(15 eyelashes)recurred,and the recurrence rate was 10.8%;5 cases(12 eyelashes)received 2nd-3rd treatments,and 3 cases were cured,with a total cure rate of 77.4%and a total recurrence rate of 6.5%.There was no statistically significant difference in the cure rate after the 1st laser surgery between the two groups(P>0.05).The recurrence rate after the first laser surgery in group A was higher than that in group B,and the difference was statistically significant(P<0.05).The total cure rate of group A was higher than that of group B,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the total recurrence rate between the two groups(P>0.05).There was no eyelid margin deformity and any scar in the two groups after surgery,and postoperative visual acuity was not affected.Conclusion 532 nm laser is a simple,accurate,fast and minimally invasive treatment for trichiasis.The cure rate and recurrence rate are different depending on the application of power,and a personalized treatment plan can be selected according to the specific situation of the patient.