Mechanism of selective laser trabeculoplasty:a systemic review

Although selective laser trabeculoplasty(SLT)is a recognized method for the treatment of glaucoma,the exact changes in the target tissue and mechanism for its intraocular pressure lowing effect are still unclear.The purpose of this review is to summarize the potential mechanisms of SLT on trabecular meshwork both in vivo and in vitro,so as to reveal the potential mechanism of SLT.SLT may induce immune or inflammatory response in trabecular meshwork(TM)induced by possible oxidative damage etc,and remodel extracellular matrix.It may also induce monocytes to aggregate in TM tissue,increase Schlemm’s canal(SC)cell conductivity,disintegrate cell junction and promote permeability through autocrine and paracrine forms.This provides a theoretical basis for SLT treatment in glaucoma.

Selective laser trabeculoplasty

The introduction of selective laser trabeculoplasty (SLT) provided a new choice for the reduction of intraocular pressure (IOP) in eyes with open angle glaucoma (OAG) and ocular hypertension (OHT). SLT was demonstrated equally as effective as topical medical therapy and argon laser trabeculoplasty (ALT) to lower IOP. It is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork (TM) and also effect in patients with previously failed ALT. SLT can be used to treat patients with OAG, pseudoexfoliation glaucoma, pigmentary glaucoma, normal-tension glaucoma, OHT, juvenile glaucoma, pseudophakic and aphakic glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with medications, while not interfering with the success of future surgery. Its safety profiles include mild and transient inflammation, ocular pain and a small risk of moderate IOP elevations after the procedure. SLT is a safe and effective means of IOP reduction in eyes with OAG and OHT.

Efficacy of low-energy selective laser trabeculoplasty on the treatment of primary open angle glaucoma

AIM: To investigate the efficacy of low-energy selective laser trabeculoplasty(SLT) on the treatment of primary open angle glaucoma(POAG) patients.METHODS: Outpatients with POAG who underwent 360-degree SLT using an initial energy of 0.3 mJ(total energy of 30-40 mJ) were reviewed retrospectively from September 2011 to January 2018.RESULTS: Eight-six eyes of 44 POAG patients underwent 360-degree SLT using initial energy of 0.3 mJ and were followed up regularly. The total energy used was 32.5±2.5 mJ(23-40 mJ, 105±6 spots). The average pretreatment intraocular pressure(IOP) was 19.8±3.9 mm Hg. At 1, 3, 6 mo, 1, and 2 y, the post-SLT IOPs(mm Hg) were 16.9±3.3, 16.5±3.3, 17.1±3.4, 16.6±3.5, 16.5±2.8, which were significantly lower than that before treatment(P<0.001). The patients in the SLT success group were found to be younger than those in the SLT failure group. After SLT, 59 eyes that maintained pretreatment medications were defined as the drug retention group. The pre-SLT IOP was 20.1±3.7 mm Hg.At 1, 3, 6 mo, 1, and 2 y, the post-SLT IOPs(mm Hg) were 17.3±3.6, 16.6±3.5, 17.2±3.6, 16.9±3.8 and 16.5±2.9, respectively. Twenty-seven eyes that required reduced drugs were defined as the drug reduction group. The pre-SLT IOP was 19.2±4.4 mm Hg. At 1, 3, 6 mo, 1, and 2 y, the post-SLT IOPs(mm Hg) were 16.1±2.6, 16.5±3.1, 16.8±2.9, 16.0±2.6 and 16.3±2.4, respectively. Compared with the pretreatment IOPs, the post-SLT IOPs were significantly lower in drug retention group and drug reduction group. The patients in the drug reduction group were found to be younger than those in the drug retention group.CONCLUSION: Low-energy SLT is safe and effective for POAG patients during a 2-year follow-up. Younger POAG patients may obtain better results after low-energy SLT treatment.

Selective laser trabeculoplasty in patients with pseudoexfoliative glaucoma vs primary open angle glaucoma： a one-year comparative study

AIM：To compare the efficacy of single-session 360-degree selective laser trabeculoplasty（SLT） for reduction of intraocular pressure（IOP） in patients with pseudoexfoliative glaucoma（PXFG） and primary open angle glaucoma（POAG）.· METHODS：This is a single-center,prospective,nonrandomized comparative study.Patients older than 18 years of age with uncontrolled PXFG or POAG eyes requiring additional therapy while on maximally tolerated IOP-lowering medications were included.The primary outcome measure changed in IOP from baseline.Success was defined as IOP reduction ≥20%from baseline without any additional IOP-lowering medication.All patients were examined at 1d,1wk,1,3,6,9,12 mo after SLT.· RESULTS：Nineteen patients（20 eyes） with PXFG and27 patients（28 eyes） with POAG were included in the study.In the visual fields mean deviation was-2.88（±1.67）in the POAG and-3.1（±1.69） in the PXFG groups（P=0.3）.The mean（±SD） IOP was 22.9（±3.7） mm Hg in the POAG group and 25.7（±4.4） mm Hg in the PXFG group at baseline and decreased to 18.4（±3.2） and 18.0（±3.9） mm Hg in the POAG group（P〈0.001 and P=0.02）,and to 17.9（±4.0） and 21.0（±6.6） mm Hg in the PXFG group（P〈0.001 and P=0.47） at 6 and 12 mo,respectively.The number of medications was 2.6（±0.8） in the POAG group and 2.5（±0.8） in the PXFG group at baseline,and did not change at all follow-up visits in both groups（P =0.16 in POAG and 0.57 in PXFG）.Based on Kaplan-Meier survival analysis,the success rate was 75%in the POAG group compared to 94.1%in the PXFG group（P=0.08;Log-rank test） at 6mo,and 29.1%and 25.0%at 12 mo,respectively（P=0.9;Log-rank）.· CONCLUSION：The 360-degree SLT is an effective and well-tolerated therapeutic modality in patients with POAG and PXFG by reducing IOP without any change in number of medications.The response was more pronounced early in the postoperative period in patients with PXFG whereas there was no statistically significant difference at 12-month follow-up. 〈/tr〉

Efficacy of selective laser trabeculoplasty following incisional glaucoma surgery

AIM： To evaluate the efficacy of selective laser trabeculoplasty（SLT） in glaucomatous eyes with previous incisional glaucoma surgery. METHODS： A retrospective cohort of eyes that underwent SLT at a single institution from 2013-2015 were followed for 1 y. Reduction in intraocular pressure（IOP） following SLT was evaluated in eyes with prior trabeculectomy with Ex Press mini shunt（Alcon, Ft Worth, TX, USA）, Ahmed valve（New World Medical, Cucamonga, CA, USA）, or combined phacoemulsification-trabeculectomy. A control group was included with eyes without prior surgery that underwent SLT. Success was defined as 〉20% drop in IOP from pre-SLT baseline. RESULTS： One-hundred and six eyes were included with 53 in both the prior glaucoma surgery（PGS） and no prior glaucoma surgery（NPGS） groups. Mean pre-SLT IOP was 19.2±4.3 and 20.6±6.0 mm Hg for PGS and NPGS groups, respectively（P=0.17）. Both groups produced statistically significant IOP reductions at 1 and 6 mo（P〈0.04）. At 6 mo, mean IOP reduction reached 7.3% and 10.8% for the PGS and NPGS groups, respectively（P=0.42）. Overall, 27.9% and 31.7% of eyes in PGS and NPGS groups met success criteria at 1 y（P=0.70）. In the PGS group, eyes with baseline IOP ≥21 mm Hg had IOP reductions of 18.1%（P〈0.001）, 16.7%（P〈0.01）, and 8.4%（P=0.31） compared to eyes with baseline IOP 〈21 mm Hg who had IOP reductions of 2.3%（P=0.39）, 3.4%（P=0.19）, and 1.1%（P=0.72） at 1, 6 mo, and 1 y, respectively. CONCLUSION： SLT is efficacious in eyes with prior incisional glaucoma surgery and results in similar IOP reductions compared to eyes without PGS. A larger IOP reduction is observed following SLT in eyes with higher pre-SLT IOP.

Comparison of success rate and intraocular pressure spikes between selective laser trabeculoplasty and micropulse laser trabeculoplasty in African American and Hispanic patients

AIM:To examine the efficacy and safety of micropulse laser trabeculoplasty(MLT)versus selective laser trabeculoplasty(SLT)in a large cohort of primarily African American and Hispanic patients.METHODS:A single center retrospective comparative cohort review conducted at Cook County Health facilities that included patients with a diagnosis of open angle glaucoma or ocular hypertension who received an SLT or MLT procedure between January 2017 and May 2021.RESULTS:Totally 131 eyes of 99 patients were analyzed.The 77 eyes received SLT and 54 received MLT.Seven out of 77 eyes in the SLT group(9.1%)and 1 out of 54 eyes in the MLT group(1.9%)had an IOP spike(defined as>5 mm Hg)at either 1h or 1wk after procedure(P=0.05,Chisquared test with Haldane-Anscombe correction).The procedure failure rate at one year was 50%for SLT and 48%for MLT(P=0.31).CONCLUSION:MLT has a significantly lower incidence of pressure spikes and a similar treatment failure rate at 1-year post-procedure,demonstrating that it is a reasonable alternative compared to SLT.

Selective Laser Trabeculoplasty Complicated by Cystoid Macular Edema:Report of Two Cases

Purpose: Selective laser trabeculoplasty,a relatively novel treatment for open angle glaucoma,is frequently associated with mild post-operative intraocular inflammation. Methods: We report two uncommon cases of cystoid macular edema within a few weeks of routine selective laser trabeculoplasty. Results:Visual acuities and macular thicknesses of the two cases returned to baseline after medical treatment,but in one case, the cystoid macular edema persisted for months. Conclusion:Cystoid macular edema after selective laser trabeculoplasty is fortunately a rare complication, but it might be more common in patients with predisposing factors, and it can be resistant to treatment.

Long-term outcomes in patients initially responsive to selective laser trabeculoplasty

AIMTo determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT).METHODSThe Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT.RESULTSSeventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (&#x000b1;14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P&#x0003c;0.001, P&#x0003c;0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both.CONCLUSIONSLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.

Selective laser trabeculoplasty in pseudophakic and phakic eyes:a prospective study

AIM：To compare the efficacy of selective laser trabeculoplasty（SLT） in replacing medical therapy in pseudophakic and phakic eyes.METHODS：Subgroup of a prospective randomized clinical trial including patients with primary open angle glaucoma or ocular hypertension controlled with medication.Of 38 pseudophakic eyes were matched with 38 phakic eyes.SLT was offered as a way to decrease medication while maintaining the same low eye pressure.SLT was performed over 360°,at 3ns,spotsize 400 μm,100 spots.Data [intraocular pressure（IOP）,number of medications needed] were measured at 1h,1wk,1,3,6 and 12 mo.An independent-samples t-test was performed to compare baseline characteristics of the phakic and the pseudophakic group and differences in evolution of mean IOP and number of used medications.Chi-squared analysis was performed to investigate proportions of fast,slow and non-responders.RESULTS：The mean IOP measurement was 13.00± 2.88 mm Hg in the phakic group（38 eyes） and 13.51±3.06 mm Hg in the pseudophakic group（38 eyes）（P〉0.05）.This changed little after SLT and IOP lowering effect was comparable between the two groups.Main aim however was to lower the amount of medication needed.In the phakic group medication lowered from 1.29±0.62 at baseline,to 0.15±0.46 after 12mo;a reduction of 88.37%.In the pseudophakic group,used medication changed from 1.71±1.04,to 0.41±0.61;a 76.02% reduction.The differences were not statistically significant at any time point（P〉0.05）.IOP lowering occurred slightly faster in thepseudophakic group（50% of patients after one week） than in the phakic group（68% of patients after more than 4wk）.The difference was not significant（P〉0.05）.CONCLUSION：IOP lowering effect of SLT is comparable between phakic and pseudophakic eyes.

Effects of primary selective laser trabeculoplasty on anterior segment parameters

AIMTo investigate the effects of selective laser trabeculoplasty (SLT) on the main numerical parameters of anterior segment with Pentacam rotating Scheimpflug camera in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG).METHODSPentacam measurements of 45 eyes of 25 (15 females and 10 males) patients (12 with OHT, 13 with POAG) before and after SLT were obtained. Measurements were taken before and 1 and 3mo after SLT. Pentacam parameters were compared between OHT and POAG patients, and age groups (60y and older, and younger than 60y).RESULTSThe mean age of the patients was 57.8±13.9 (range 20-77y). Twelve patients (48%) were younger than 60y, while 13 patients (52%) were 60y and older. Measurements of pre-SLT and post-SLT 1mo were significantly different for the parameters of central corneal thickness (CCT) and anterior chamber volume (ACV) (P<0.05). These parameters returned back to pre-SLT values at post-SLT 3mo. Decrease of ACV at post-SLT 1mo was significantly higher in younger than 60y group than 60y and older group. There was no statistically significant difference in Pentacam parameters between OHT and POAG patients at pre- and post-treatment measurements (P>0.05).CONCLUSIONSLT leads to significant increase in CCT and decrease in ACV at the 1st month of the procedure. Effects of SLT on these anterior segment parameters, especially for CCT that interferes IOP measurement, should be considered to ensure accurate clinical interpretation.

Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes

BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

Selective laser trabeculoplasty:a review of repeatability

The efficacy of selective laser trabeculoplasty(SLT)to treat open-angle glaucoma(OAG)and ocular hypertension(OHT)has been increasingly substantiated lately.Repeated SLT is usually needed to control intraocular pressure(IOP),be it as primary or adjunctive therapy.We review the studies available,in terms of SLT repeatability;and conclude comparable efficacy,with success rate,duration and complications similar to those in initial SLT.

Where does selective laser trabeculoplasty stand now? A review

Background:Chronic treatment of glaucoma can present a challenge in patients who lack the means and/or the discipline to use daily glaucoma medication.We wondered if selective laser trabeculoplasty(SLT)could be a useful alternative.Methods:Inclusion criteria:controlled trials comparing efficacy of SLT in adult patients with any form of open angle glaucoma or ocular hypertension and case reports on side effects of SLT.Two recent meta-analyses identified eight randomized clinical trials(RCTs)comparing the effect of SLT with medication(prostaglandin analogs)and with argon laser trabeculoplasty(ALT).We took these eight RCTs as reference base and calculated their success rates where they were not given.Other articles were added to elaborate on technique and side effects.Results:Mean intraocular pressure(IOP)reduction after SLT was 3.8–8.0 mmHg after 6 months to 1 year.Mean success rate of SLT at 6 months to 1 year is 55–82%.Higher IOP before laser predicts a higher IOP-lowering effect.In terms of mean IOP reduction,reduction in number of medications and treatment success,the effect of SLT was found to show no clinically relevant difference from that of contemporary medication(prostaglandin analogs)and from ALT.Conclusions:The evidence indicates that SLT is an efficacious primary or adjunctive therapy for treating glaucoma.

选择性激光小梁成形术治疗各类型开角型青光眼临床疗效的研究

目的观察选择性激光小梁成形术(selectlasertrabecularplasty,SLT)治疗各类型开角型青光眼(openangleglaucoma,OAG)降低眼内压的临床疗效和临床反应。方法对27例(52眼)多种类型开角型青光眼进行SLT治疗。所用设备为CoherentSelecta7000倍频Q-开关NdYAG双频激光仪。80个非重叠激光斑打击在颞侧180°范围小梁网,能量0.4～1.0mJ,激光斑400μm。术后观察眼内压和前房反应,时间为1d,1,6mo,1a。全部患者定期检查视力、裂隙灯、眼底镜、房角镜、视野(Octopus视野仪)、海德堡共焦激光断层扫描仪,(HRT-ⅡONH)和眼前节生物超声(UBM)检查。结果患者术前眼压平均(26.87±2.6)mmHg,不同时期的眼压大部分改善,术后1a为(20.21±3.4)mmHg,下降幅度为(6.66±2.8)mmHg,相当于下降24.78%,有3眼为高眼压症,没有明显降压效果出现。2眼为发育性青光眼,术后5d内降眼压效果明显,但10d左右眼压回升到接近术前水平转为手术治疗。部分病例仍需配合局部降眼压药。视力、C/D比、房角镜无明显改变。1a视野检查,9眼有改善。结论SLT治疗多种类型开角型青光眼安全有效,没有明显副作用和并发症,是治疗开角型青光眼的有效方法之一。

选择性激光小梁成形术治疗硅油眼继发性青光眼的疗效

目的分析选择性激光小梁成形术(SLT)治疗硅油眼继发性青光眼的临床疗效。方法选择硅油填充术后继发性青光眼患者18例(18眼),行SLT治疗(360°小梁网,击射100点),随访观察患者激光并发症、眼压和联合降眼压药物使用情况。结果 SLT治疗后,出现轻度眼部胀痛4眼(22.2%),轻度结膜充血8眼(44.4%),前葡萄膜炎7眼(38.9%),前房出血1眼(5.56%),一过性高眼压3眼(16.7%)。患者平均眼压由SLT治疗前的(25.56±3.09)mmHg降至治疗后的(20.17±2.57)mmHg,差异具有统计学意义(t=8.581,P=0.000 1)。患者使用的降眼压药物种类由治疗前的人均(2.167±0.514)种降至治疗后的(1.333±0.840)种,差异具有统计学意义(t=4.499,P=0.000 3)。结论 SLT可安全、有效地治疗硅油眼继发性青光眼。

选择性激光小梁成形术治疗残余原发性闭角型青光眼的临床评价

背景选择性激光小梁成形术（SLT）治疗原发性开角型青光眼（POAG）的安全性和有效性已得到人们广泛的认同，但迄今为止SLT治疗闭角型青光眼的研究较少，其效果和安全性尚待临床观察证实。目的评价SLT治疗残余原发性闭角型青光眼（PACG）的疗效及安全性。方法采用病例观察性研究设计。共纳入经激光周边虹膜成形术和／或激光虹膜周边切除术治疗后前房角开放但眼压不能降至正常的闭角型青光眼患者23例33眼，术前平均眼压（24．78±4．48）mmHg，日平均用药指数（1．62±0．66）分。所有眼的前房角能看到小梁网的范围约180。。用Q开关倍频Nd：YAG激光机在患眼开放的前房角照射小梁网，在180。范围内照射70-80点。术后继续使用术前的降眼压药物，术后随访9个月，定期复查眼压、视力、眼前节炎症反应和房水流畅系数测定值，并用前房角镜检查房角的开放情况。结果本组术眼术后1d，1周，1、3、6、9个月的平均眼压分别为（18．78±4．87）、（18．83．4±3．95）、（19．78±4．48）、（19．63±3．68）、（19．11±3．36）、（21．17±3．14）mmHg，与术前眼压值（24．78±4．48）mmHg比较，术后1～9个月明显下降，差异均有统计学意义（P〈0．05）。各时间点患眼日平均用药指数分别为（1．63．4±0．85）、（1．23±1．01）、（1．25±0．98）、（1．21±1．02）、（1．22±0．86）、（1．69±0．53）分，术后1周，1、3、6个月与术前值的（1．62±0．66）分比较，差异均有统计学意义（P＝0．020、0．026、0．020、0．031）。术后即刻可见睫状体充血和前房闪辉，1周后自然消退。16眼术前和术后3个月的平均房水流畅系数（C值）分别为0．11±0．09和0．23±0．15，差异有统计学意义（P=0．002）。结论SLT能够安全有效地降低部分闭角型青光患者的眼压，但其前提是必须有1／2周的虹膜小梁角是开放的。

选择性激光小梁成形术对开角性青光眼的疗效

目的 :观察选择性激光小梁成形术对降低开角性青光眼患者眼压的临床疗效。方法 :每眼使用倍频 Q-开关 ND:YAG激光进行 180°或 36 0°治疗。术后测 1h、2 h,1d,1、2、3、4、8周眼压。结果 :术前平均眼压 (2 2 .15±3.44 ) mm Hg(范围 19～ 3.17) mm Hg,术后 8周平均眼压 (16 .6± 3.76 ) m m Hg(范围 12 .3～ 2 3) mm Hg。结论 :SL T对开角性青光眼具有良好的降压效果。

三种抗青光眼药物对选择性激光小梁成形术疗效的影响

目的分析单独局部使用β受体阻滞剂、α受体激动剂或前列腺素类滴眼液是否影响高眼压症或原发性开角型青光眼患者接受选择性激光小梁成形术(selective laser trabeculoplasty,SLT)的疗效。方法前瞻性分析2009年6月至2011年7月上海交通大学附属第一人民医院眼科收治的患者73例(73眼)。其中药物组52例(包括分别单独使用β受体阻滞剂21例、α受体激动剂14例、前列腺素类药物17例),对照组21例;所有患者接受全周(360°)SLT治疗并随访观察6个月。将眼压降幅≥20%判定为治疗有效。结果治疗后2周、1个月、3个月和6个月药物组整体与对照组眼压值组间差异均无统计学意义(t值分别为-0.222、-0.651、-0.549和-1.153,P值分别为0.825、0.517、0.585和0.253);分别单独使用β受体阻滞剂、α受体激动剂或前列腺素类药物的患者之间眼压值差异均无统计学意义(F值分别为1.010、0.650、0.170和0.950,P值分别为0.371、0.527、0.847和0.396。各观察期药物组整体与对照组治疗有效率组间差异均无统计学意义(χ2值分别为0.041、0.020、0.478和0.262,P值分别为0.839、0.886、0.489和0.609);分别单独使用β受体阻滞剂、α受体激动剂或前列腺素类药物的患者之间治疗有效率差异无统计学意义(治疗后2周有效率采用Fisher’s确切概率法(双侧),P值为1.000,治疗后1个月、3个月和6个月采用卡方检验,χ2值分别为0.904、1.169和0.343,P值分别为0.636、0.557和0.843)。结论单独局部使用β受体阻滞剂、α受体激动剂或前列腺素类抗青光眼药物对SLT的疗效没有影响。

选择性激光小梁成形术治疗激素性青光眼的疗效观察

目的:观察选择性激光小梁成形术(SLT)治疗激素性青光眼的临床疗效。方法:对全身激素用药引起的激素性青光眼8例8眼进行房角全周SLT,其中男5例,女3例,年龄55～74(平均65)岁。激素的持续用药时间为11.5±3.3a,给药开始6.2±2.9a后眼压开始上升,使用2.9±0.5种类的抗青光眼药局部点眼。SLT术后继续点眼治疗和激素口服。结果:平均眼压术前为26.8±5.1mmHg,SLT术后1mo为20.2±3.2mmHg,术后3mo为17.6±2.2mmHg,术后6mo为16.1±1.4mmHg。各时点的眼压值与术前眼压相比均有显著降低(P<0.05)。结论:SLT对于全身激素用药继发的激素性青光眼是一种安全而有效的治疗方法。

选择性激光小梁成形术治疗高眼压症和不同病程原发性开角型青光眼的疗效观察

目的对比选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗高眼压症(ocular hypertension,OHT)和早期、中期原发性开角型青光眼(primary open-angle glaucoma,POAG)的效果。方法根据病情将120例120眼患者分为OHT组(40例40眼)、早期POAG组(40例40眼)和中期POAG组(40例40眼),3组均使用532 nm倍频Q开关Nd:YAG激光器行SLT,激光单脉冲3 ns,光斑直径400 nm,初始能量为0.6 m J,以0.1 m J逐渐递减,至刚好出现香槟样气泡时为治疗能量,治疗范围为360°,术后1 d、1周、1个月、3个月及6个月随访,主要观察SLT治疗前后的眼压变化情况。结果治疗后1 d^6个月,OHT组、早期POAG组和中期POAG组术后各个时间点的眼压均较术前下降,差异均有统计学意义(均为P<0.05)。各组内,SLT术后各时间点的眼压相比,差异亦均有统计学意义(均为P<0.05)。OHT组、早期POAG组和中期POAG患者基线眼压分别为(25.95±1.80)mm Hg(1 k Pa=7.5 mm Hg)、(24.66±1.55)mm Hg和(25.62±2.67)mm Hg,差异有统计学意义(P<0.05)。当剔除基线眼压的影响之后,术后1 d、1周、1个月、3个月、6个月,3组间的眼压相比差异均有统计学意义(均为P<0.05)。在各组内,术后各时间点的眼压相比,差异亦均有统计学意义(均为P<0.05)。与校正后的基线眼压相比,OHT组SLT术后眼压下降的幅度最大,其次是早期POAG组,中期POAG组下降的幅度最小。结论 SLT对于OHT和POAG患者具有良好的降眼压效果,SLT的治疗效果随POAG患者的病情严重程度逐次递减。