810nm激光睫状体光凝治疗难治性青光眼的疗效

目的:探讨810nm激光经巩膜睫状体光凝治疗难治性青光眼的临床疗效。方法:对25例30眼难治性青光眼患者行810nm激光经巩膜睫状体光凝术,术后随访3mo,分析术后眼压、疼痛感、视力、并发症等情况。结果:术后随访期间全部患者眼痛症状均缓解。术前平均眼压为50.42±2.50mmHg,末次随访时平均眼压15.95±4.19mmHg,术后眼压与术前相比,差异有显著统计学意义(P<0.01)。光凝术后2眼(6.7%)视力提高,24眼(80.0%)视力无变化,4眼(13.3%)视力下降。术后前房渗出12眼(40.0%),前房积血3眼(10.0%),玻璃体积血1眼(3.3%),药物治疗后消失。结论:810nm激光经巩膜睫状体光凝术是治疗难治性青光眼的有效方法,能显著降低眼压,减少患者痛苦,并发症少。     

内镜下睫状体光凝治疗玻璃体切除术后青光眼的效果

目的评价内窥镜下睫状体光凝术(endoscopic cyclophotocoagulation,ECP)治疗玻璃体切除术后青光眼的效果。方法回顾性分析2015年5月至2017年12月山西省眼科医院玻璃体切除术后难治性青光眼进行ECP的30例(31只眼)的临床资料。根据光凝范围分为3组,<180°组12只眼,180°~270°组5只眼,>270°组14只眼。观察术后1周~24个月的眼压、视力及光凝范围与术后眼压降幅的关系。结果所有患者术后各时间点眼压均低于术前(F=26.82,P<0.05)。光凝范围越大,降眼压效果越显著,二者呈正相关。末次随访无需任何降眼压药物治疗而眼压正常者22例(70.97%);应用降眼压药物而眼压仍高于21 mmHg者7例(22.58%)。末次随访视力(logMAR)2.40±1.60与术前2.19±1.38比较差异无统计学意义(t=-1.18,P>0.05),随访时间87.10%(27/31)的患眼视力稳定。未出现术后低眼压、视网膜脱离、脉络膜上腔爆发性出血或眼内感染等并发症。结论ECP能有效降低玻璃体切除术后青光眼的眼压,维持视功能,无严重并发症。     

内窥镜下睫状体光凝治疗儿童青光眼的长期临床观察

目的评价内窥镜下睫状体光凝(ECP)治疗儿童青光眼的长期疗效和安全性。方法回顾性系列病例研究。收集2013年8月至2020年5月在首都医科大学附属北京同仁医院眼科中心接受内窥镜下睫状体光凝的儿童青光眼患者。观察指标包括第一次ECP手术时的年龄、青光眼类型、术前与术后最后一次随访时的视力及眼压等。采用配对t检验比较术前及术后末次随访眼压和视力。采用独立样本t检验和卡方检验比较成功组及失败组的各项临床特征。结果 22例(27眼)儿童青光眼患者纳入本研究。其中先天性白内障术后12眼,玻璃体切除视网膜复位联合硅油填充术后10眼,外伤性白内障术后2眼,先天性青光眼3眼。随访时间为6个月至6年(中位数:5年)。术前眼压为37.8±8.1 mmHg,ECP平均次数为1.2±0.6次,术后末次随访眼压为22.6±9.8 mmHg,术后眼压下降幅度约40%。末次随访时,19眼眼压控制,7眼眼压失控,1眼眼球萎缩。行1次及以上ECP手术的1年,3年,5年及6年的累积成功率分别为84.4%,71.7%,71.7%,53.8%。手术成功组首次ECP范围(均值:287^O)比失败组大(均值:223^O)。结论 ECP对治疗儿童青光眼,尤其是难治性继发性青光眼是有效的。术后眼压在药物辅助下可以长期稳定。对儿童青光眼长期乃至终身眼压随访是至关重要的。     

内窥镜下睫状体光凝和减压阀植入术治疗角膜移植术后青光眼的疗效对比

目的:探讨内窥镜下睫状体光凝和减压阀植入术治疗角膜移植术后青光眼的疗效和安全性。方法:设计回顾性研究,对46例46眼角膜移植术后继发青光眼患者分别进行内窥镜下睫状体光凝和减压阀植入术,术后1,7d;1,6mo观察两组病例视力、眼压和角膜内皮以及术后并发症等情况结果:术后两组患者随访眼压在1,7d;1mo时间点进行t检验,均显示无统计学差异,但是在第6mo时间点时ECP组眼压为平均14.1±8.4mmHg,Ahmed组眼压平均18.2±7.6mmHg,两者之间显示有统计学差异。而两组中4个随访时间的眼压值与手术前眼压进行Dunnett-t检验显示均有统计学的差异。术前ECP组平均使用降眼压药物2.3种,术后下降到0.8种,Ahmed组平均使用降眼压药物2.4种,术后下降到0.7种,两者之间显示无统计学差异。ECP组手术后4眼出现渗出膜,5眼出现前房出血。渗出性脉络膜脱离2眼,低眼压2眼。Ahmed组2眼术后出现渗出膜,3眼术后出现前房出血,浅前房5眼,脉络膜脱离6眼,低眼压3眼。结论:ECP和引流阀植入术对于角膜移植术后继发青光眼的治疗均有可靠的疗效。但ECP降眼压的远期效果较引流阀植入术好,同时适应证广,并发症少。     

玻璃体切除联合眼内镜下睫状体光凝治疗难治性青光眼

目的评价玻璃体切除联合眼内镜下睫状体光凝术治疗难治性青光眼的效果。方法对10例（10只眼）难治性青光眼均行玻璃体切除术和晶状体切除后在眼内镜下行激光睫状体光凝,激光能量0．6～0．87／,时间0．5s,光凝下方180°～220°范围,光凝30～40点。结果术后随访6～15个月,10例眼压均控制在〈21mmHg（1mmHg=0．133kPa）。最佳矫正视力提高者7例,不变者1例,不配合者1例,1例睫状体光凝术中出现脉络膜下爆发性出血。结论玻璃体切除联合眼内镜下睫状体光凝治疗难治性青光眼是一种相对有效的方法。     

Endoscopic laser cyclophotocoagulation in pediatric glaucoma with corneal opacities.

INTRODUCTION: Endoscopic diode cycloablation (ECP) has shown modest efficacy for the management of pediatric glaucomas. Eyes with pediatric glaucoma and corneal opacities pose obstacles to intraocular surgery. We examined the role of ECP in lowering intraocular pressure (IOP) as well as that of endoscopy in facilitating tube shunt placement in these eyes. METHODS: Retrospective chart review of 12 eyes (11 patients) with glaucoma and corneal opacities from 12/99 to 9/05. ECP was performed for IOP control with success defined as postoperative IOP < or =21 mm Hg, with or without medications and without procedure-related complications. Success of ECP, repeat ECP, and endoscopically guided tube shunt placement was studied. RESULTS: Diagnoses included the following: Peters/anterior segment dysgenesis in nine eyes and corneal scar/failed corneal graft in three. Patients included eight females and three males with median age 3 years (0.5 to 10.3) at treatment. Median number of prior surgeries was three; median time to failure was 7.8 months (0.3 to 38). Ten eyes had prior external cycloablation(s). Success of first ECP (mean 6.1 clock hours) was 2/12 (17%), with Kaplan-Meier median survival 12 months. Two treatment failures had repeat ECP, and both failed. Four treatment failures had subsequent tube shunt surgery (three with endoscopic assistance), and all were successful at median follow-up of 33 months (11 to 63). Baseline IOP was 36.8 +/- 11 mm Hg before ECP versus 28.2 +/- 16 mm Hg after first treatment (p = 0.07). Procedure-related complications included chorioretinal detachment in one eye. CONCLUSIONS: ECP had limited success in children with refractory glaucoma. However, with anatomic limitations, endoscopy itself was valuable in facilitating subsequent successful tube shunt surgery.     

Contact transscleral diode cyclophotocoagulation for refractory glaucoma

PURPOSE: To evaluate the effect of contact transscleral diode cyclophotocoagulation on intraocular pressure (IOP), vision, number of medications, and complications in a heterogenous population of patients with refractory glaucoma. METHODS: Clinical data for all patients undergoing contact transscleral diode cyclophotocoagulation for refractory glaucoma at the Medical College of Georgia between November 1994 and November 1996 were reviewed. Forty-seven eyes of forty-seven patients followed for at least one month were included. Visual acuity, IOP, number of medications, and complications were noted for follow-up periods as long as 24 months. RESULTS: At final follow-up examination (range 1-24 months, median 9 months), the average decrease in IOP was 21+/-16 mmHg. Thirty-one (66%) patients had final IOP between 7 and 21 mmHg. Medications were decreased by an average of 1.1. Twenty-six (62%) of 42 patients with vision before surgery had stable or improved visual acuity at the final follow-up visit; 16 (38%) had a deterioration in visual acuity. Neovascular glaucoma was associated with a posttreatment IOP less than 7 mmHg. CONCLUSION: Contact transscleral diode cyclophotocoagulation is effective in lowering IOP in eyes with refractory glaucoma. It also serves to reduce the number of medications required for appropriate IOP control. Loss of visual acuity remains an important concern. Acute complications tend to be transient. Further study is needed to identify patients at risk for markedly reduced IOP after this procedure and for modulation of the protocol to decrease such risk.     

眼内窥镜下睫状体光凝对角膜植片存活的影响

目的探讨对穿透性角膜移植术（PKP）后眼压升高且药物不能控制的患者,采用眼内窥镜直视下睫状体光凝术（ECP）进行治疗的疗效和对角膜植片存活的影响。方法选择2000年3月至2004年4月期间,于中山大学中山眼科中心就诊的34例（34只眼）PKP术后眼压升高且药物不能控制患者,在眼内窥镜直视下,行半导体激光睫状体光凝术（12例）或联合玻璃体切除术（22例）（ECP组）。选择26例（26只眼）患者作为对照,采用经巩膜面半导体激光睫状体光凝术（TCP）（TCP组）。术前、术后随访观察视力、眼压、植片透明度、内皮细胞密度及前房反应,超声活体显微镜（UBM）检查睫状突和房角情况,注意术后并发症等。结果ECP组术后3个月和6个月时,分别有13例（38．2％）和23例（67．7％）眼压低于21mmHg。TCP组术后3个月和6个月时,分别有10例（38．5％）和8例（30．8％）眼压低于21mmHg。两组之间术后眼压控制率比较,在3个月时差异无统计学意义（X^2=0．0003,P=0．986）,但6个月时差异有统计学意义（X^2=8．024,P=0．005）。ECP组和TCP组术后植片内皮细胞密度分别为（1013±170）个／mm^2和（847±136）个/mm^2,差异有统计学意义（t=-0．009,P=0．033）。ECP组和TCP组术后分别有9例（26．5％）和21例（80．8％）出现反应性虹膜炎,两组之间比较差异有统计学意义（x^2=17．376,P=0．001）。结论ECP对降低PKP术后青光眼患者眼压的远期疗效优于TCP。ECP对角膜植片内皮细胞的损伤和引起术后葡萄膜炎的程度均较TCP轻,相对提高了PKP术后角膜植片的生存质量。     

难治性青光眼睫状体光凝疗效观察

目的:评价激光经巩膜睫状体光凝术(transscleral cyclo-photocoagulation,TSCPC)治疗难治性青光眼的临床疗效。方法:对36眼难治性青光眼采用低能量1.5~2.1W,多点数10~32的TSCPC,术后随访观察并记录眼压,视力,眼部自觉症状以及并发症,随访时间约3mo。结果:术前平均眼压62.89±17.36mmHg,最后随访平均眼压为21.13±7.06mmHg,经配对资料t检验,术前眼压与术后眼压相比,差别具有统计学意义(P<0.05)。手术有效率83%。指数以上视力10眼中术后6眼视力无变化,4眼视力提高。6眼眼压控制欠佳,行睫状体冷冻手术。术前所有眼痛的患者眼痛均消失或缓解,并发症少,程度轻,主要有色素膜炎,前房出血等,无眼球萎缩发生。结论:TSCPC是难治性青光眼的一种简单安全有效的治疗方法。     

经巩膜睫状体光凝治疗难治性青光眼的临床观察

目的:评价半导体激光经巩膜睫状体光凝术治疗难治性青光眼的效果。方法:回顾性分析55例56眼难治性青光眼的临床资料,均行睫状体光凝,术后随访观察并记录眼压、视力、眼部自觉症状以及并发症,随访时间3mo以上。结果:术前平均眼压53.5±18.7mmHg,末次随访平均眼压为19.4±9.6mmHg,术后眼压与术前眼压相比,差别具有统计学意义(P<0.01)。术后44眼视力无变化,2眼视力提高,10眼视力下降;眼痛均消失或缓解;并发症少,主要有葡萄膜炎、前房出血等。结论:睫状体光凝能有效降低难治性青光眼患者的眼压,且并发症少。     

A prospective, comparative study between endoscopic cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma

PURPOSE: To compare endoscopic cyclophotocoagulation (ECP) and the Ahmed drainage implant in the treatment of refractory glaucoma. METHODS: Sixty-eight eyes of 68 patients with refractory glaucoma were prospectively assigned to either ECP or Ahmed tube shunt implantation. All procedures were performed by a single surgeon. Eyes that were included were pseudophakic with a history of at least one trabeculectomy with antimetabolite, an intraocular pressure (IOP) equal to or above 35 mm Hg on maximum tolerated medical therapy, and a visual acuity better than light perception. Exclusion criteria included eyes that had had previous glaucoma drainage device implantation or a cyclodestructive procedure. Success was defined as an IOP more than 6 mm Hg and less than 21 mm Hg, with or without topical anti-hypertensive therapy. RESULTS: The mean follow-up was 19.82 +/- 8.35 months and 21.29 +/- 6.42 months, for the Ahmed and ECP groups, respectively (P = 0.4). The preoperative IOP, 41.32 +/- 3.03 mm Hg (Ahmed) and 41.61 +/- 3.42 mm Hg (ECP) (P = 0.5), and the mean postoperative IOP, at 24 months follow-up, 14.73 +/- 6.44 mm Hg (Ahmed) and 14.07 +/- 7.21 mm Hg (ECP) (P = 0.7), were significantly different from baseline in both groups (P < 0.001). Kaplan-Meier survival curve analysis showed a probability of success at 24 months of 70.59% and 73.53% for the Ahmed and ECP groups, respectively (P = 0.7). Complications included choroidal detachment (Ahmed 17.64%, ECP 2.94%), shallow anterior chamber (Ahmed 17.64%, ECP 0.0%), and hyphema (Ahmed 14.7%, ECP 17.64%). CONCLUSION: There was no difference in the success rate between the Ahmed Glaucoma Valve and ECP in refractory glaucoma. The eyes that underwent Ahmed tube shunt implantation had more complications than those treated with ECP.     

Efficacy and safety of contact transscleral diode laser cyclophotocoagulation for advanced glaucoma

BACKGROUND: This prospective study was conducted to evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation in refractory, advanced glaucoma. PATIENTS AND METHODS: One hundred eyes of 100 patients with advanced glaucoma refractory to medical treatment were consecutively treated by transscleral diode laser cyclophotocoagulation. Success was defined as a final intraocular pressure between 5 and 21 mm Hg in eyes with a visual acuity of more than hard movements, relief of pain in eyes with a visual acuity of hand movements or less including blind eyes, and reduction of carbonic anhydrase inhibitor use in all eyes. RESULTS: Ninety-three patients were followed up for 1 year after initial treatment. The overall success rate was 74.2%. Of 60 eyes with a visual acuity of more than hand movements, intraocular pressure between 5 and 21 mm Hg was achieved in 41 (68.3%) eyes. Relief of pain was achieved in 28 (84.8%) of 33 eyes. Reduction of systemic carbonic anhydrase inhibitor use was highly significant (P < 0.0001). Within 1 year, 173 laser procedures (mean, 1.9 per patient) were performed. The probability of success increased significantly (P = 0.004) with the age of the patients, from 55% for patients younger than the age of 50 years to 83% for patients older than the age of 50 years. Previous ocular surgery decreased the success probability from 95% to 68% (P = 0.02). A high success rate was achieved in inflammatory glaucoma (75%), primary open-angle glaucoma (89.5%), and neovascular glaucoma (86.7%). The results were relatively poor in traumatic glaucoma (57.1%), aphakic glaucoma (57.1%), and congenital or juvenile glaucoma (62.5%). No significant relationship between loss of visual acuity and failure of treatment (P = 0.3) could be detected. No phthisis bulbi or persistent hypotonia developed. CONCLUSIONS: Transscleral diode laser cyclophotocoagulation is an effective and safe method for the treatment of advanced, refractory glaucoma. However, repeated treatments are often necessary. Success of treatment depends on the age of patients, previous surgery, and the type of glaucoma.     

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。     

Trans-scleral diode laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma

PURPOSE: To evaluate the success rate of contact diode transscleral cyclophotocoagulation (TSCPC) in pediatric refractory glaucoma. PATIENTS: and method: Twenty-eight eyes of 28 patients (age range 5 months to 26 years) with medical and surgical refractory pediatric glaucoma due to primary congenital glaucoma (group 1, 20 eyes) or aphakic congenital glaucoma (group 2: 8 eyes), were included in this retrospective study. All eyes underwent one or more TSCPC with the diode laser (Oculight SLX, Iris Medical) with a minimal follow-up of 2 months. Success was defined as intraocular pressure (IOP) between 6 and 20 mmHg after one or more procedures, with no increase in medical hypotensive therapy, and no progression to another hypotensive procedure. RESULTS: Mean baseline IOP was 29.4 +/- 7.8 mmHg (range 25 to 60 mmHg) and mean follow-up was 10.3 +/- 6.9 months (range 2 to 26 months). Success rates evaluated at 6 and 12 months (Kaplan Meier survival curves) were 54.4% and 27.7% respectively, with one-third of the eyes retreated once or more. These success rates were similar in both groups with a mean baseline IOP decrease of 38.9 +/- 15.9%. Postoperative uncontrolled hypertony occurred in the first 3 months in 6 (21.4%) eyes, leading to surgical IOP management. Other complications were decrease in visual acuity (14.3%), inflammation (25.5%) and phthisis (3.5%). CONCLUSION: TSCPC with the diode laser is a disappointing procedure for the management of refractory pediatric glaucoma, with poor mid-term IOP control and high incidence of complications including severe uncontrolled IOP increase. For these reasons, this cyclodestructive procedure should be considered as a last resort therapy for patients with refractory pediatric glaucoma.     

Endoscopic cyclophotocoagulation: an overview and Asian perspective

Surgical treatment of glaucoma has been classified as cyclodestructive (reducing inflow) or filtering (increasing outflow). Cyclodestructive procedures have traditionally been reserved for eyes with poor visual prognoses and refractory glaucomas including post-trauma, aphakia, congenital and developmental glaucoma. Since Uram described the first use of endoscopic cyclophotocoagulation (ECP) in 1992, short and long-term outcomes for ECP have been promising. In the present article, we conduct a Pubmed search and review of published English literature on endoscopic cyclophotocoagulation and comparison with limited results in a single Singapore ophthalmic tertiary hospital. Safety and efficacy of ECP and combined phacoemulsification-ECP procedures in treatment of pediatric and adult glaucomas of various etiologies and severities is reported. Local short-term unpublished results from a single Singapore tertiary ophthalmic service is reported and concurs with previously published results.Published reports and current experience with ECP has demonstrated that ECP with direct visualization of the target tissues avoids the complications associated with blind trans-scleral cyclophotocoagulation by applying optimum energy to target tissue ciliary epithelium with endoscopic visualization and infrared laser wavelength application. Significant financial barriers exist to introducing this service. It is safe and effective in controlling IOP and reducing reliance on anti- glaucoma medications. Widespread acceptance and use of this technique awaits large-scale randomized controlled studies.     

Transscleral red-laser cyclophotocoagulation combined with limited anterior retinal cryocoagulation in neovascular glaucoma

PURPOSE: To evaluate transscleral contact red-laser cyclophotocoagulation (CPC), using a visible red 647-nm krypton or 670-nm diode laser and limited transscleral anterior retinal cryocoagulation in neovascular glaucoma. METHODS: In a retrospective case series, 35 eyes of 35 consecutive patients treated during a period of 6 years were included in the study. Inclusion was dependent on follow-up of at least 1 month. Patients who had undergone previous cyclodestructive procedures and patients who received an additional glaucoma operation in conjunction with CPC were excluded. In the combined procedure, the power per CPC application was 370-450 mW and exposure time was 10 seconds. One to two rows of cryoapplications were given to 360 degrees of the anterior retina. RESULTS: The success rate in terms of intraocular pressure (IOP of 8-21 mmHg or a decrease in IOP > 30%) was 89% at the last follow-up (17 +/- 15 months). Iris neovascularization regressed in 51% of eyes. Hypotonia developed in one (3%) eye (IOP of 5 mmHg). No cases of phthisis bulbi were seen. Visual acuity (VA) declined in 49% of eyes. CONCLUSIONS: A combination of transscleral contact red-laser CPC with limited anterior retinal cryocoagulation is efficient in lowering IOP in neovascular glaucoma and is well tolerated. During follow-up, a decrease in VA occurs in a significant proportion of patients.     

经巩膜睫状体光凝术治疗难治性青光眼的效果

目的评价经巩膜睫状体光凝术(TCP)治疗难治性青光眼的效果。方法回顾性研究。对北京爱尔英智眼科医院2017年7月至2018年12月行TCP治疗的难治性青光眼73例(81只眼)的临床资料进行分析。观察手术前后眼压、降眼压药物使用种类、术中光凝情况和并发症的发生。术后随访6个月。结果术前眼压(35.0±8.8)mmHg(1mmHg=0.133 kPa);术前使用降眼压药物3(3,4)种;术中光凝能量(2027.00±235.88)mW、光凝范围238.0°±44.7°、光凝点数(31.00±7.17)个;术后1 d眼压为(18.67±7.13)mmHg,术后1个月眼压(18.50±8.28)mmHg,术后3个月眼压(19.25±6.79)mmHg,术前与术后各时间点眼压差异均有统计学意义(t=14.496、12.775、11.277、11.802,均P<0.05);术后使用降眼压药物0(0,1)种;术后视力不变65只眼(80.2%);各类型难治性青光眼手术成功率70.0%~87.5%;术后长期低眼压2只眼,眼球萎缩2只眼。结论TCP可有效治疗难治性青光眼,对继发性青光眼效果优于原发性青光眼。     

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。     

Valve implants of glaucoma pressure regulator for refractory glaucoma: own experience

PURPOSE: To present our experiences in valve implantation for refractory glaucoma. MATERIAL AND METHODS: From October 1993 to December 1996 implantations of Glaucoma Pressure Regulator Optimed were performed in 7 eyes of 7 patients. There were 4 men and 3 women aged from 32 to 65 years. There were 3 eyes with neovascular glaucoma due to diabetes mellitus, 2 eyes with posttraumatic glaucoma, including 1 case after keratoplasty, 1 eye with postkeratoplasty glaucoma and 1 eye with aphakic glaucoma. Preoperative IOPs ranged from 33 to 61 mm Hg (mean 37.6 +/- 7.2 mm Hg). RESULTS: Success was considered an IOP of less than 22 mm Hg without medication (complete success) or with medication (qualified success) without additional filtering surgery. Postoperative success was obtained in 4 out of 7 eyes after follow-up period of 37.4 +/- 17.08 months (range 16-39 months). Early complications were hyphema (1 patient, 14.3%), blockage of intracameral portion of the tube (1 patient, 14.3%), hypertony (1 patient, 14.3%). Late complications were: external conjunctival bleb failure (2 patients, 28.6%), blockage of intracameral portion of tube by fibrovascular tissue (1 patient, 14.3%). CONCLUSION: Our experiences confirm that the valve implant is still today an alternative surgical procedure for controlling IOP in eyes with refractory glaucoma that have visual potential.     

透巩膜睫状体光凝治疗眼外伤玻璃体手术后难治性青光眼

目的探讨810激光透巩光凝治疗眼外伤玻璃体切除术后难治性青光眼的效果。方法回顾复杂性眼外伤玻璃体手术后难治性青光眼36例（36眼）,包括开放性眼外伤Ⅱ期玻璃体切除后青光眼21眼,眼球挫伤玻璃体切除或玻璃体切除联合晶状体切除后青光眼15眼。采用G探头810激光透巩膜睫状体光凝术,功率1500～2000mW,时间1500～2000mS。光凝范围90°-270°,光凝点数12～30点。术后随访3～12个月。结果36眼中,手术前后的眼压分别是（40．21±14．46mmHg）和（20．53±6．70）mmHg,手术后眼压明显下降,（t=6．08,P〈0．001）,27眼眼压控制在21mmHg以下。25眼视力提高,8眼无变化,3眼视力下降。术中结膜灼伤3眼。术后1眼眼球萎缩。结论透巩膜睫状体光凝治疗眼外伤玻璃体手术后难治性青光眼是一种有效的方法。