532 nm微脉冲激光小梁成形术治疗原发性开角型青光眼的效果分析

The efficacy of 532 nm micropulse laser trabeculoplasty for primary open angle glaucoma

目的探讨532 nm微脉冲激光小梁成形术(micropulse laser trabeculoplasty,MLT)治疗原发性开角型青光眼(primary open angle glaucoma,POAG)降眼压效果。设计回顾性病例系列。研究对象43例POAG患者。方法22例患者将MLT作为首次初始治疗(MLT组),21例患者将药物局部治疗作为起始治疗方案,但未达到目标眼压或随诊视野进行性缩窄或神经纤维层厚度进行性变薄,采用MLT作为追加治疗(药物+MLT组)。全部病例采用统一激光参数,由同一名眼科医师操作。主要指标眼压降幅,治疗成功率。结果术后1小时、1天、1周、1个月、3个月、6个月眼压分别为(19.9±4.7)mmHg、(17.9±4.5)mmHg、(18.5±4.4)mmHg、(16.8±4.2)mmHg、(16.7±4.2)mmHg和(17.5±5.2)mmHg(F=3.088,P=0.006)。MLT组、药物+MLT组均在激光术后1个月时降眼压幅度达到最大。与正常眼压组相比,基线时高眼压患者激光术后降眼压幅度较大,术后1天、1周、1个月、3个月、6个月降眼压幅度差异均有统计学意义(P<0.001)。术后1个月眼压较基线下降约17.8%。术后6个月总体成功率为50.0%,药物+MLT组的完全成功率为54.2%,MLT组为42.9%(χ2=1.42,P=0.39)。所有治疗患者术后未见前房积血及角膜损伤。结论532 nm MLT可作为POAG的一线治疗手段,对于药物治疗效果不理想的患者MLT仍可作为辅助治疗手段,且安全有效。(眼科,2024,33:182-186)

Objective To investigate the efficiency of 532nm micropulse laser trabeculoplasty(MLT)in reducing intraocular pressure(IOP)in patients with primary open-angle glaucoma(POAG).Design Retrospective case-series.Participants 43 patients with POAG.Methods 22 patients received MLT as the initial treatment,while 21 patients received topical medication as the initial treatment but failed to achieve the target IOP or showed progressive narrowing of visual field or thinning of the nerve fiber layer,and then MLT was used as additional treatment.All cases were treated with unified laser parameters and operated by the same ophthalmologist.Main Outcome Measures IOP reduction,treatment success rate.Results IOP after laser treatment 1 hour,1 day,1 week,1 month,3 month,and 6 month were(19.9±4.7)mmHg,(17.9±4.5)mmHg,(18.5±4.4)mmHg,(16.8±4.2)mmHg,(16.7±4.2)mmHg and(17.5±5.2)mmHg,respectively(F=3.088,P=0.006).Both the MLT group and the drug combined MLT group reached the maximum IOP reduction at 1 month after laser surgery.Compared with the group with normal baseline IOP,the amplitude of postoperative IOP reduction was larger in patients with elevated IOP after 1 day,1 week,1 month,3 month,and 6 month treatment(all P<0.001).The IOP decreased by about 17.8%from baseline at 1 month follow-up.The overall success rate was 50.0%at 6 months follow-up,54.2%in the drug combined MLT group and 42.9%in the MLT group(χ2=1.42,P=0.39).Hyphema,cornea injuries were not observed in all treated patients.Conclusion 532 nm MLT is effective and safe to be used as an initial treatment in patients with POAG,also a good assistant treatment for patients with topical medication.(Ophthalmol CHN,2024,33:182-186)