眼内窥镜下睫状体光凝术治疗常规抗青光眼手术失败的外伤性青光眼的疗效分析

目的探讨眼内窥镜下睫状体光凝术(ECP)治疗外伤性难治性青光眼的安全性和有效性。设计回顾性病例系列。研究对象2013年5月至2020年5月北京同仁医院接受至少一次抗青光眼手术且术后眼压仍>21 mmHg的外伤性难治性青光眼患者24例(24眼)。方法采用ECP对所有患者进行治疗。术后平均随访(3.6±2.3)年(范围6个月~7年)。回顾患者术前、术后1天、术后1周及末次随访时的眼压、视力、降眼压药物使用、术后并发症情况。采用单因素重复测量方差分析(ANOVA)和配对t检验进行数据分析。主要指标眼压、视力、降眼压药物使用情况。结果术前患者平均眼压(37.8±8.7)mmHg,末次随访时平均眼压为(21.9±6.9)mmHg(P<0.001),83.3%患者眼压≤21 mmHg。术前使用降眼压药物(2.75±0.79)种,末次随访时为(0.88±1.12)种(P<0.001)。末次随访时87.5%患者视力不变或提高。术中及术后均无严重并发症发生。结论平均随访3.6年的结果显示,ECP治疗常规抗青光眼手术失败的外伤性青光眼的疗效良好。

Treatment efficacy of endoscopic cyclophotocoagulation on post-traumatic refractory glaucoma

Objective To explore the safety and effectiveness of endoscopic cyclophotocoagulation(ECP) in the treatment of posttraumatic refractory glaucoma.Design Retrospective case series.Participants 24 eyes of 24 post-traumatic refractory glaucoma patients who previously had undergone anti-glaucoma surgeries at least 1 time at Beijing Tongren Hospital from May 2013 to May 2020.Methods ECP was used to treat all patients.Patients were followed up for at least 6 months and average 3.6±2.3 years(range 6 months to 7 years).Changes in intraocular pressure(IOP),visual acuity,the number of IOP-lowering drugs and complications were reviewed.The data were analyzed by ANOVA and paired t test.Main Outcome Measures IOP,visual acuity and the number of IOP-lowering drugs.Results The average pre-operation IOP was 37.8±8.7 mmHg.The IOP at last visit(21.9±6.9 mmHg) was significantly lower than that before the ECP(P<0.001),and the IOP was successfully controlled in 83.3%.The number of IOP-lowering drugs used before operation was 2.75±0.79,and it was 0.88±1.12 at the last follow-up after ECP.The difference was statistically significant(P<0.001).The postoperative visual acuity remained unchanged or improved in 87.5% of the patients.There was no severe complication observed during or after ECP.Conclusion The average follow-up of 3.6 years showed that ECP was effective in the treatment of traumatic refractory glaucoma.