二极管激光经巩膜睫状体光凝术治疗穿透性角膜移植术后难治性青光眼的疗效观察

Observation on effect of transscleral diode laser cyclophotocoagulation for refractory glaucoma after penetrationg keratoplasty

目的 :观察接触性二极管睫状体光凝术治疗穿透性角膜移植术后难治性青光眼的效果和对角膜植片的影响。方法 :使用IRIS OculightSLX二极管激光系统 ,光凝角巩膜缘外 1 2mm处 ,范围 180°～ 36 0° ,能量 1 7～ 2 6W ,2 0～ 4 0点 ,对 2 4例穿透性角膜移植术后难治性青光眼患者共 2 4只眼行 1～ 3次半导体二极管睫状体光凝术 ,随访时间≥ 9个月者被列入本研究。结果 :眼压 :治疗前在用抗青光眼药物的情况下眼压为 (32± 9 7)mmHg(2 7～ 5 9mmHg)。激光治疗后一周内眼压明显降低 ,随访 9～ 16个月 (平均 11 4个月 ) ,末次随访眼压为 (18± 5 8)mmHg(8～ 2 8mmHg) ,眼压平均降低 14mmHg。视力 :末次随访视力从 0 2到手动 ,手术后视力无改变者 16只眼 (6 6 7% ) ,下降者 6只眼 (2 5 % ) ,提高者 2只眼 (8 2 % )。角膜植片 :术前植片透明者 16只眼 ,半透明 2只眼 ,混浊 6只眼 ,术前植片透明眼在术后有 3只眼 (19% )发生排斥反应致植片混浊 ,排斥均发生在术后 3个月内 ,术前植片半透明的 2只眼在术后植片亦变混浊。结论 :接触性二极管睫状体光凝术简单易行 ,安全有效 ,可重复进行。对于多次行其它抗青光眼手术治疗 ,眼压不能控制的穿透性角膜移植术后难治性青光眼 ,是一个较好的选择。

Objective:To observe the effect of contact transscleral diode laser cyclophotocoagulation in patients with refractory glaucoma after penetrating keratoplasty and its influence on corneal graft.Method:IRIS Oculight SLX diode laser system was used,the probe foot was placed on the outer edge of limbus,and laser photocoagulation was performed in 180°～360°,with energy 1 7～2 6W,shot 20～40.Twenty four patients(24 eyes)with refractory glaucoma postpenetrating keratoplasty were treated 1～3 times.Patients whose follow up time was 9 months or over were included in this study.Results:Intraocular pressure(IOP):Pretreatment IOP in the use of anti glaucoma medications was(32±9 7)mmHg(27～59mmHg).IOP was significantly decreased within one week after treatment.After follow up 9～16 months(average 11 4 months),IOP of last visit was(18±5 8)mmHg(8～28mmHg),and the average IOP was decreased 14mmHg.Visual acuity:At last follow up,the visual acuity ranged from 0 2 to hand motion.Posttreatment visual acuity was not changed in 16 eyes(66 7%),decreased in 6 eyes(25%)and improved in 2 eyes(8 2%).Corneal graft:Prior to treatment there were 16 clear grafts,2 half clear and 6 failed grafts.After treatment 3 grafts(19%)became failed due to allograft rejection from 16 pretreatment clear grafts.The all rejection occurred within 3 months after treatment.The 2 half clear grafts also became failed.Conclusion:Contact diode transscleral cyclocoagulation is easy,safe to perform,and can be repeat performed.To those eyes with refractory glaucoma postpenetrating keratoplasty after multi anti glaucoma surgeries,it is a better choice for controlling IOP.