眼内窥镜下激光睫状体光凝术治疗难治性青光眼的疗效评价

目的探讨眼内窥镜下激光睫状体光凝术(endoscopic cyclophotocoagulation,ECP)治疗难治性青光眼的疗效和安全性。方法采用EndoOptiksURAM-E2激光内窥镜系统对47例(51只眼)难治性青光眼患者进行ECP治疗(有4只眼接受2次治疗),观察患者术后眼压变化、视力及并发症情况,术后分别随访6~16个月,平均10·8个月。结果51只眼术前用药情况下眼压平均为(35·3±13·0)mmHg(1mmHg=0·133kPa),术后1周眼压平均为(19·9±13·2)mmHg,术后1个月眼压平均为(22·0±11·6)mmHg,术后3个月眼压平均为(17·6±11·6)mmHg,术后6个月眼压平均为(17·0±10·4)mmHg,术前、后眼压差异有统计学意义(P<0·01)。术前平均使用降眼压药物3·3种,术后下降至1·0种,差异有统计学意义(P<0·01)。术后无需应用药物治疗,而眼压≤21mmHg者26只眼,占51·0%;应用局部药物治疗情况下,眼压≤21mmHg者13只眼,占25·5%。患者术后视力较术前增高,差异有统计学意义(P<0·01)。51只眼中,有4只眼术后出现少量前房积血,分别于术后2~5d吸收;有23只眼术后瞳孔区出现纤维素样渗出,加强抗感染治疗后均在1周内吸收;2只眼术后发生渗出性脉络膜脱离,分别于7、16d复位。所有患者术后均未出现人工晶状体偏位或脱位、眼压过低、视网膜脱离、脉络膜上腔出血、眼内炎或交感性眼炎等并发症。结论ECP能有效地降低难治性青光眼的眼压,手术操作简单,无明显严重并发症。ECP是治疗难治性青光眼的安全而有效的手术方法之一。

The clinical study of endoscopic cyclophotocoagulation on the management of refractory glaucoma

OBJECTIVE: To evaluate the efficacy and safety of endoscopic cyclophotocoagulation (ECP) in the management of refractory glaucoma. METHODS: ECP procedures were performed on fifty-one eyes of 47 patients with refractory glaucoma by using the Microprobe (Endo Optiks, URAM E2) integrated laser endoscope system. All patients were followed-up from 6 to 16 months (mean 10.8 months), with four eyes receiving a second treatment. The changes of intraocular pressure (IOP), visual acuity and complication were pre- and post-operatively observed. RESULTS: Compared to preoperation, the IOP of postoperation was significantly (P < 0.01) decreased at week 1, 4, 12, and 24 [(35.3 +/- 13.0) mm Hg (1 mm Hg = 0.133 kPa) vs (19.9 +/- 13.2) mm Hg, (22.0 +/- 11.6) mm Hg, (17.6 +/- 11.6) mm Hg, and (17.0 +/- 10.4) mm Hg, x +/- s, respectively]. The mean number of IOP-decreased drugs used was significantly (P < 0.01) reduced from 3.3 to 1.0 of postoperation. 51.0% of all 51 eyes with the postoperative IOP less than 21 mm Hg did not receive any drug, and 25.5% with supplemental drug treatment. The visual acuity was significantly (P < 0.01) improved postoperatively. Postoperative hyphema were found in 4 eyes, fibrous exudates in 23 eyes, and exudative choroids detachment in 2 eyes, all of which occurred at the early postoperative stage and were healed within 2-16 days. No other complications were observed. CONCLUSION: ECP is a safe and effective procedure for the management of refractory glaucoma without serious complications.