微脉冲经巩膜激光治疗难治性青光眼有效性及安全性评估:前瞻性多中心观察研究

Efficacy and safety of micropulse transscleral cyclophotocoagulation in the treatment of refractory glaucoma:a prospective multicenter observational study

目的评估微脉冲经巩膜激光(MP-TSCPC)治疗难治性青光眼的有效性及安全性。方法采用前瞻性多中心系列病例观察研究,对2022年8月至2023年4月在中山大学中山眼科中心、成都市第一人民医院(成都市中西医结合医院)和长沙爱尔眼科医院拟行MP-TSCPC治疗的难治性青光眼患者63例67眼,其中抗青光眼术后眼压未降40眼(占59.7%),玻璃体切割术后继发性青光眼4眼(占6.0%),角膜移植术后继发性青光眼2眼(占3.0%),新生血管性青光眼8眼(占11.9%),虹膜角膜内皮综合征继发性青光眼3眼(占4.5%),原发性开角型青光眼6眼(占9.0%),原发性闭角型青光眼4眼(占6.0%)。采用ETDRS视力表及Goldmann压平眼压计分别测量患者术前和术后6个月内最佳矫正视力(BCVA)及眼压。记录患者术前和术后抗青光眼药物使用情况及术后并发症发生情况。计算手术成功率,手术成功定义为末次眼压较基线降低>20%或眼压不变但使用的抗青光眼药物减少。结果手术前后不同时间点眼压总体比较差异有统计学意义(F=60.10,P<0.001),其中术后不同时间点眼压均明显低于术前,差异均有统计学意义(均P<0.001)。术后6个月眼压降幅为(43.7±20.7)%。术后使用抗青光眼药物数量为2(0,3)种,较术前的3(2,3)种明显减少,差异有统计学意义(Z=-2.70,P=0.007)。术眼术后6个月BCVA(LogMAR视力)为1.40(0.52,2.70),较术前的1.40(0.70,2.70)无明显变化,差异无统计学意义(Z=-0.10,P=0.952)。术后6个月手术成功率为83.6%(56/67)。手术并发症主要包括瞳孔扩大(11/67)、结膜出血(11/67)、轻微前房炎症(1/67)、轻度睫状体脱离(3/67)、局部脉络膜脱离(1/67)和黄斑囊样水肿(1/67),均在药物治疗后好转。结论MP-TSCPC是治疗难治性青光眼安全、有效的方法。

Objective To evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation(MP-TSCPC)for refractory glaucoma.Methods A prospective multicenter observational case series study was conducted.A total of 63 refractory glaucoma patients(67 eyes)who underwent MP-TSCPC treatment were enrolled at Zhongshan Ophthalmic Center,Sun Yat-sen University,Chengdu First People's Hospital(Chengdu Integrated TCM&Western Medicine Hospital),and Changsha Aier Eye Hospital from August 2022 to April 2023.Among these cases,there were 40 eyes(59.7%)with unreduced intraocular pressure(IOP)after glaucoma surgery,4 eyes(6.0%)with secondary glaucoma after vitrectomy,2 eyes(3.0%)with secondary glaucoma after keratoplasty,8 eyes(11.9%)with neovascular glaucoma,3 eyes(4.5%)with secondary glaucoma due to iridocorneal endothelial syndrome,6 eyes(9.0%)with primary open-angle glaucoma and 4 eyes(6.0%)with primary angle-closure glaucoma.Best corrected visual acuity(BCVA)was measured using the ETDRS chart and the IOP was measured using the Goldmann applanation tonometry before and 6 months after the surgery.The usage of anti-glaucoma medications before and after surgery and postoperative complications were recorded.Surgical success rate was calculated and surgical success was defined as an IOP reduction of more than 20%from baseline or a reduction in the number of ocular hypotensive medications with no change in IOP.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center,Sun Yat-sen University(No.2022KYPJ225).Written informed consent was obtained from each subject.Results There was a statistically significant overall difference in IOP at different time points before and after surgery(F=60.10,P<0.001),and the IOP at different time points after surgery was significantly lower than that before surgery,with statistically significant differences(all at P<0.001).IOP reduction at 6 months after surgery was(43.7±20.7)%.The number of anti-glaucoma medications used postoperatively was 2(0,3)types,which was significantly less than the 3(2,3)types used preoperatively(Z=-2.70,P=0.007).The 6-month postoperative BCVA(LogMAR)was 1.40(0.52,2.70),which showed no significant change compared to the preoperative 1.40(0.70,2.70)(Z=-0.10,P=0.952).The surgical success rate was 83.6%(56/67)at 6 months postoperatively.Postoperative complications included mydriasis(11/67),conjunctival hemorrhage(11/67),mild anterior chamber inflammation(1/67),mild ciliary body detachment(3/67),local choroidal detachment(1/67),and cystoid macular edema(1/67),all of which were reversible after treatment.Conclusions MP-TSCPC appears to be a safe and effective treatment option for refractory glaucoma.