经巩膜睫状体光凝术治疗晚期青光眼的临床对比研究

目的探讨应用半导体激光经巩膜集中强化睫状体光凝术及传统经巩膜睫状体光凝术治疗晚期青光眼的疗效及安全性。方法青光眼患者85例共87只眼，其中男55例，女30例，年龄40～89岁，平均68．7岁。随机分成两组，改良组42例（43眼），眼压为（54．03±12．43）mmHg（1mmHg=0．133kPa），经巩膜集中强化睫状体光凝。传统组43例（44眼），眼压为（52．4±18．63）mmHg，行传统的经巩膜均匀分散睫状体光凝治疗，记录激光能量、光凝的范围及治疗点数。术后随访12～24个月，平均（15．68±4．43）月，观察指标包括眼压、视力、眼部症状及眼球萎缩发生率。结果改良组术前平均眼压为54．03±12．43mmHg，术后随访眼压平均为（15．05±4．81）mmHg，术前术后眼压差异有统计学意义（P〈0．05）。传统组术前眼压平均为（52．4±18．63）mmHg，术后随访眼压平均为（11．32±3．56）mmHg，术前术后眼压差异有统计学意义（P〈0．05）。改良组40眼治愈，手术成功率93．02％。传统组37眼治愈，手术成功率84．09％。两组疗效比较，无显著性差异（P〉0．05）。改良组43眼中0眼发生眼球萎缩，传统组44眼中6眼（13．6％）发生了眼球萎缩，两组眼球萎缩发生率比较，有显著性差异（P〈0．05）。结论应用半导体激光经巩膜集中强化睫状体光凝是治疗晚期青光眼有效且更安全的治疗方法。

The clinical effect of transscleral cyclophotocoagulation on advanced stageglaucoma

Objective To investigate the clinical effect and safety of centered enrichment transscleral cyclophotocoagulation and traditional transscleral cyclophotocoagulation on advanced stage glaucoma. Methods 85 patients （87eyes） with advanced stage glaucoma were randomly divided into 2 groups, including improvement group and tradition group. In improvement group, 42 patients （43 eyes） were treated with centered enrichment transscleral cyclophotocoagulation. In tradition group, 43 patients （44 eyes） were treated with traditional transscleral cyclophotocoagulation. The energy of laser light, the scope of photocoagulation extent and treat points were observed. They were followed up for 12-24 months. Clinical data including intraocular pressure （lOP）, visual acuity, eye symptom and incidence of atrophia bulbi were analyzed. Results In improvement group, IOP before and after operation were 54. 03±12.43mmHg and 15.05±4. 81 mmHg, respectively, which was statistically different from each other （P〈0.05）. In tradition group, IOP before and after operation wee 52.4±18.63mmHg and 11.32±3.56mmHg, respectively （P〈0.05）. In improvement group, 40 eyes were cured and the effective rate was 93.02%. In tradition group, 37 eyes were cured and the effective rate was 84. 09%. There was no statistical difference between effective rate of the two groups （P〉0. 05）. There were 0 and 6 eyes with atrophia bulbi in improvement group and tradition group （P〈0.05）, respectively. Conclusion Centered enrichment transseleral cyclophotoeoagulation was useful and safe to treat advanced stage glaucoma.