飞秒激光辅助白内障手术在青光眼治疗中的应用进展

Application progress of femtosecond laser-assisted cataract surgery in glaucoma

飞秒激光辅助白内障手术(FLACS)的应用已有10余年的历史,其安全性与精准性已得到验证。近年来FLACS已逐步应用于青光眼合并白内障患者,尤其是原发性闭角型青光眼(PACG)患者,因其独特的解剖特点使得常规白内障手术晶状体摘除难度与潜在并发症增加,FLACS用于PACG患者优势明显。新近报道FLACS联合微创青光眼手术(MIGS)应用于开角型青光眼患者、联合房角分离术(GSL)用于闭角型青光眼患者,甚至用于抗青光眼术后存有滤过泡的患者,其适应证日趋拓展。FLACS可导致术中短暂眼压升高,眼部参数对术中眼压可产生一定影响,对眼压的远期影响有待进一步研究。FLACS对青光眼患者视功能的影响及其产生的相关并发症应引起重视。文章就FLACS在各类青光眼中的应用、对眼压和视功能的影响、特殊并发症及应用前景做一综述。

Femtosecond laser-assisted cataract surgery(FLACS)has been used for more than 10 years,with its safety and precision well-verified.In recent years,FLACS has been gradually applied to patients with glaucoma and cataracts,especially those patients with primary angle closure glaucoma(PACG).The unique anatomical characteristics of PACG increase the difficulty of lens extraction and potential complications in conventional phacoemulsification surgery,highlighting the distinct advantages of FLACS in these patients.Recently,the application of FLACS combined with minimally invasive glaucoma surgery(MIGS)in patients with open angle glaucoma,and goniosynechialysis(GSL)in patients with angle-closure glaucoma,and even in patients with filtering blebs after anti-glaucoma surgery,has been reported.The indications for FLACS are increasingly expanding.FLACS can cause a transient intraoperative increase in intraocular pressure(IOP),and ocular parameters can have a certain impact on IOP.The long-term effects on IOP require further research.More attention should be paid to the impact of FLACS on visual function in glaucoma patients and the related complications that may arise.This article reviews the application of FLACS in different types of glaucoma,its effects on IOP and visual function,specific complications,and application prospects.