经巩膜睫状体光凝作为青光眼首选手术方式的探讨及展望

睫状体光凝是难治性青光眼的主要治疗手段之一,其降眼压速度快、效果佳,但由于存在眼球萎缩和视力下降的风险,使其临床应用受到限制.经巩膜睫状体光凝的术后效果及并发症的发生主要与激光能量、点数、范围等操作参数以及患者眼部色素水平有关.其降眼压作用不依赖于房角开放状况,对操作技术要求相对较低.随着技术的进步和光凝参数的优化,睫状体光凝的安全性和有效性较前大大提高.同时由于其非侵入的特性,避免了许多青光眼滤过手术相关的严重并发症.结合地区经济发展水平、医疗资源配置情况、患者意愿和随访依从性等因素,近年来有研究者尝试将经巩膜睫状体光凝用于视力尚好的原发性开角型青光眼患者和药物控制不佳的慢性闭角型青光眼,并作为新生血管性青光眼的首选手术治疗方案,取得了较好效果,为青光眼的治疗提供了新的思路.本文对经巩膜睫状体光凝的安全性、有效性及其影响因素进行了综述,同时对其作为青光眼患者首选手术治疗方案的可能性和可行性作以分析、探讨和展望.

Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for glaucoma-questions and future

Cyclophotocoagulation is one of the efficacious procedures for the treatment of refractory glaucoma.However,its clinical utilization is limited due to severe post-operative complications including phthisis and visual loss.Transscleral cyclophotocoagulation (TCP) is technically simple and less affected by the opening status of the anterior chamber angle.Its effectiveness and complications are mainly related to the energy,spots and scale of the surgery,as well as the ocular pigmentation of the patients.With the advance of technology,both the effectiveness and safety of this procedure gain significant improvement.Meanwhile,it is free from the filtration surgery-related complications due to its noninvasive characteristics.Taken the local economic level,medical resources allocation,as well as the patients' preference and follow-up into account,utilization of TCP on primary open angle glaucoma (POAG) patients with good vision,or as primary surgical treatment for medically uncontrolled chronic angle closure glaucoma (CACG) and neovascular glaucoma (NVG) were recently tried and showed good preliminary results.It provides new insight in glaucoma therapy,although further evidence from prospective,random control trials are still needed.In present review,both the safety and efficiency,as well as related influent factors of TCP were summarized.The possibility and feasibility of this procedure as a primary surgical treatment for glaucoma were discussed.