选择性激光小梁成形术

选择性激光小梁成形术 (SLT)通过选择性作用于色素性小梁网以改善房水的流出通道 ,从而达到降低眼内压 ,治疗原发性开角型青光眼的目的。研究表明 ,SLT无热损伤、可重复治疗、降眼压疗效显著而安全 ,是治疗原发性开角型青光眼的又一新措施。     

选择性激光小梁成形术

选择性激光小梁成形术（SLT）通过选择性作用于色素性小梁网以改善房水的流出通道，从而达到降低眼内压，治疗原发性开角型青光眼的目的。研究表明，SLT无热损伤、可重复治疗、降眼压疗效显而安全，是治疗原发性开角型青光眼的又一新措施。     

选择性激光小梁成形术的临床研究进展

选择性激光小梁成形术（SLT）是治疗开角型青光眼的一种新型激光手术,它应用倍频Q-开关、波长532nm的Nd：YAG激光,选择性作用于色素性小梁组织达到降低眼压目的。目前SLT已被用于初诊、药物治疗无效、氩激光小梁成形术（ALT）后失败或小梁切除手术失败、残余性青光眼和激素性青光眼等多种开角型青光眼患者,其术后效果不尽相同。影响选择性激光小梁成形术疗效的因素包括患者的术前眼压、小梁网色素含量、术前抗青光眼药物的使用以及激光的应用范围等。选择性激光小梁成形术疗效的长期性及其重复治疗的效果尚需进一步的观察和研究。     

选择性激光小梁成形术的研究进展

青光眼是全球第一大不可逆的致盲性眼病,通过药物、激光和手术降低眼压是治疗青光眼的基本方法。选择性激光小梁成形术(SLT)是应用倍频Q开关、波长532 nm的掺钕钇铝石榴石激光,选择性作用于色素性小梁组织达到降低眼压目的。近30年来,SLT在不引起小梁网凝固性损伤的情况下可以降低眼压,已经逐渐成为治疗以原发性开角型青光眼为主的各种类型青光眼的初始治疗或替代治疗方法之一。本文中笔者就SLT的历史沿革、降眼压机制、临床应用、初始治疗、重复治疗、治疗成功的预测因素、并发不良反应、成本效益及健康相关生活质量等方面进行综述。     

选择性激光小梁成形术研究进展

激光治疗是青光眼治疗的重要手段之一。选择性激光小梁成形术（SLT）选择性作用于小梁网的色素细胞,避免了对周边组织的损害,同时可起到一定程度的降眼压作用,其机制复杂,目前尚不完全明确。相关研究显示,对于开角型青光眼,SLT具有与氩激光小梁成形术（ALT）以及药物治疗相似的效果,在部分复杂病例及闭角型青光眼中也显示了一定的降眼压作用,术后反应较轻,且可以重复操作,将会越来越受到重视。就SLT的原理、临床应用进展及其并发症等进行综述。     

选择性激光小梁成形术治疗开角型青光眼的研究进展

选择性激光小梁成形术（selective laser trabeculoplasty,SLT）采用倍频Q开关Nd：YAG激光,选择性作用于色素小梁网,而对邻近无色素小梁网不产生热损伤和凝固性破坏,目前对其作用机制的研究多集中于细胞因子的作用和后基因水平的改变.在SLT问世之初主要应用于原发性开角型青光眼的治疗,随着对其研究的深入,近年来SLT又被证明对其他类型的开角型青光眼也是安全有效的.在传统治疗参数的基础上,有学者认为低能量激光可以取得更好的疗效.目前已证实的影响SLT的降压效果的因素为基线眼压,基线眼压越高,效果越好.SLT术后常见的并发症包括一过性眼压升高、前房炎性反应以及结膜充血等.SLT的治疗能量与范围的选择、是否能替代传统的药物治疗而作为原发性开角型青光眼患者的初始治疗方法及其与药物配合治疗的最佳方案等问题仍需进一步研究探讨.     

青光眼激光治疗的新进展

近年来,激光用于青光眼的治疗随着激光技术和眼内窥镜技术的不断发展而有了新的进展。选择性激光小梁成形术（SLT）、内窥镜下睫状体光凝术（ECP）和激光小梁切开术（LTA）等以其安全、有效、并发症少等优点而受到关注。SLT选择性作用于色素性小梁细胞,无热损伤,其降眼压疗效显著而安全。ECP是在眼内窥镜引导下对睫状体进行光凝,手术定位准确、并发症少,对难治性青光眼有较好的降眼压效果。LTA是用激光将部分小梁组织切除,建立直接通向Schlemm管的通道,而无须损伤结膜,是一种很有希望的抗青光眼手术。就SLT、ECP和LTA的新进展进行综述。     

选择性激光小梁成形术治疗青光眼的临床观察

目的评价选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)的疗效和安全性。方法选择局部用药眼压不能控制的原发性开角型青光眼20例(37眼),正常眼压性青光眼6例(10眼)。观察应用选择性激光小梁成形术后6个月眼压的变化。结果术后眼压平均降低幅度为4.86±2.14mmHg(24.04±10.21%),两组患眼的眼压在激光治疗后均有显著下降:开角型青光眼组术后6个月的眼压较术前平均下降5.44±2.32mmHg(24.90±11.09%);正常眼压性青光眼组平均下降2.71±1.12mmHg(19.06±7.19%)。术后暂时的眼压升高、前房炎症反应为常见的并发症。结论选择性激光小梁成形术具有降眼压效果明显、安全、实用、损伤小、可重复等特点,是治疗青光眼的一种较安全有效的方法。     

超声乳化联合选择性小梁激光成形术在开角型青光眼中的作用

目的：比较选择性小梁激光成形术(SLT)和超声乳化联合选择性小梁激光成形术(Phaco+SLT)在药物控制良好的开角型青光眼(POAG)中的降眼压作用。

方法：采用前瞻性临床病例对照研究,24例30眼药物控制眼压良好的开角型青光眼随机分为两组,其中Phaco+SLT组11例14眼; SLT组13例16眼。测量术后3,6,9mo的眼压及术后9mo的视力和抗青光眼用药数量。

结果：两组术后平均眼压比术前眼压明显降低。Phaco+SLT组在术后6,9mo的平均眼压明显低于SLT组,两组眼压比较有统计学意义(P=0.001); 两组术后抗青光眼用药数量比术前明显降低,两组间比较有统计学意义(P=0.03)。

结论：Phaco+SLT和SLT能明显降低开角型青光眼患者眼压,Phaco+SLT降眼压作用明显优于SLT。     

选择性激光小梁成形术治疗开角型青光眼

开角型青光眼(open angle glaucoma，OAG)的临床治疗是国内外眼科专家关注的课题之一。Wise和Witter 1979年首次报道氩激光小梁成形术(argonlaser trabecnlo plasty，ALT)可成功地降低眼压。2001年11月美国眼科学会会议上讨论了选择性激光小梁成形术(select laser trabecularplasty．SLT)对OAG治疗的有效性，美国FDA通过了SLT可以用于临床的报告。我     

Selective laser trabeculoplasty

The introduction of selective laser trabeculoplasty (SLT) provided a new choice for the reduction of intraocular pressure (IOP) in eyes with open angle glaucoma (OAG) and ocular hypertension (OHT). SLT was demonstrated equally as effective as topical medical therapy and argon laser trabeculoplasty (ALT) to lower IOP. It is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork (TM) and also effect in patients with previously failed ALT. SLT can be used to treat patients with OAG, pseudoexfoliation glaucoma, pigmentary glaucoma, normal-tension glaucoma, OHT, juvenile glaucoma, pseudophakic and aphakic glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with medications, while not interfering with the success of future surgery. Its safety profiles include mild and transient inflammation, ocular pain and a small risk of moderate IOP elevations after the procedure. SLT is a safe and effective means of IOP reduction in eyes with OAG and OHT.     

Selective laser trabeculoplasty: a new treatment option for open angle glaucoma

Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with open angle glaucoma. The preservation of the trabecular meshwork architecture and the demonstrated efficacy in lowering intraocular pressure makes the SLT a reasonable and safe alternative to argon laser trabeculoplasty. In addition, SLT is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork and the demonstrated efficacy in patients with previously failed argon laser trabeculoplasty treatment. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with their glaucoma medications, while not interfering with the success of future surgery. Due to its nondestructive properties and low complication rate, SLT has the potential to evolve as an ideal first-line treatment in open angle glaucoma.     

选择性激光小梁成形术和氩激光小梁成形术治疗开角型青光眼的Meta分析

目的:评价选择性激光小梁成形术和氩激光小梁成形术在控制开角型青光眼眼压方面的效果。方法:通过计算机和手工检索Cochrane图书馆临床对照试验数据库(2008年第1期),OVID(1971～2008),Medline(1971～2008),EMBASE(1974～2008)数据库以及中国生物医学文献数据库(CBM),CNKI(1971～2008),VIP(1989～2008),收集选择性激光小梁成形术和氩激光小梁成形术治疗开角型青光眼的临床随机及半随机对照试验。两位研究者独立地进行研究的选择、质量评价和资料提取,而后采用RevMan4.2.10统计软件进行Meta分析。结果:最终纳入4个随机对照试验共292眼。4个试验的质量等级为B级。Meta分析结果显示:选择性激光小梁成形术和氩激光小梁成形术在控制开角型青光眼眼压方面差异无统计学意义。根据目前证据不能表明两种手术术后1a内在降低开角型青光眼眼压方面何者更优。结论:选择性激光小梁成形术在控制开角型青光眼眼压方面,并不优于传统的氩激光小梁成形术。     

Predictive factors of successful selective laser trabeculoplasty in open-angle glaucoma

BACKGROUND: The aim of this study was to determine factors that predict successful selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG). PATIENTS AND METHODS: In 122 eyes suffering from OAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66, 72, 78 and 84 months thereafter. Success was defined as an IOP reduction exceeding 20 % of the pretreatment IOP. Correlations between successful SLT and baseline IOP, age, sex, hypertension, diabetes mellitus, family history of glaucoma, previous anterior segment surgery, the grade of trabecular meshwork pigmentation, laser energy used, and local antiglaucoma therapy were determined. RESULTS: The mean follow-up time was 43.4 months (SD: 25.6). The mean pretreatment IOP was 22.5 mmHg (SD: 2.8). The success rate after 12 months determined from the Kaplan-Meier survival analysis was 88 %, after 24 months 79 %, after 36 months 67 %, after 48 months 58 %, after 60 months 49 % and after 84 months 48 %. We found statistically significant negative correlation betweens successful SLT and the grade of trabecular meshwork pigmentation (r = -0.234; p = 0.01), diabetes mellitus (r = -0.223; p = 0.014). We found no statistically significant correlations between successful SLT and baseline IOP, age, sex, hypertension, family history of glaucoma, previous anterior segment surgery, laser energy used, local antiglaucoma therapy. CONCLUSION: SLT success in OAG with a mean follow-up time of 43.4 months was significantly predicted by the lower grade of trabecular meshwork pigmentation and the absence of diabetes mellitus.     

Selective laser trabeculoplasty

Selective laser trabeculoplasty (SLT) has been shown to be safe, well tolerated, and effective in intraocular pressure (IOP) reduction as therapy in several forms of open-angle glaucoma. The preservation of trabecular meshwork (TM) architecture and the demonstrated efficacy in lowering IOP make SLT a reasonable and safe alternative to argon laser trabeculoplasty (ALT). SLT may also be effective for cases of failed ALT and is a procedure that may also be repeatable, unlike ALT. SLT is also a simple technique for an ophthalmologist to learn as the large spot size eliminates the need to locate a particular zone of treatment on the TM. SLT has been demonstrated to be effective as primary treatment for open angle glaucoma and can be an effective adjunct in the early treatment of glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or who are noncompliant with their glaucoma medications, without interfering with the success of future surgery.     

Selective laser trabeculoplasty: a review

The introduction of selective laser trabeculoplasty (SLT) has renewed interest in laser trabeculoplasty for the reduction of intraocular pressure (IOP) in eyes with glaucoma. This review was undertaken to address frequently raised issues pertinent to SLT in clinical practice. On the basis of the peer-reviewed medical literature, SLT demonstrates equivalent efficacy and comparable safety to argon laser trabeculoplasty, and is also equally as effective as topical medical therapy. SLT's safety profile includes mild and transient inflammation, ocular pain, and a small risk of moderate IOP elevations after the procedure. The mechanism of action of SLT is not known. SLT delivers less energy to the trabecular meshwork and generates less damage to angle tissues. Whether this renders SLT more repeatable than argon laser trabeculoplasty has not been evaluated in published data. SLT seems to be a safe and effective means of IOP reduction in eyes with glaucoma, and can reasonably be applied as primary or adjunctive therapy.     

Pressure reduction after selective laser trabeculoplasty with two different laser systems and after argon laser trabeculoplasty--a controlled prospective clinical trial on 284 eyes

BACKGROUND: Selective laser trabeculoplasty (SLT) is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. The laser parameters of a Q-switched, frequency-doubled Nd:YAG-laser are set to selectively target pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT acts non-thermally, the intracellular microdisruptions triggered by the laser are confined to the targeted cells, the laser pulses are so short that heat caused within the targeted cells does not have time to spread to the surrounding tissue. A controlled prospective randomised clinical study was conducted to compare the long-term results, safety and efficacy after SLT with two different laser systems and after ALT in the treatment of ocular hypertension and medically uncontrolled open angle glaucoma. PATIENTS AND METHODS: About two years ago the authors performed a selective laser trabeculoplasty in 119 eyes using the SLT laser unit Otello (Glautec AG, ARC, EC), here named as SLT-I, and in 124 eyes using the SLT laser unit Selecta II (Lumenis, Palo Alto, CA), here named as SLT-II. In 41 eyes the authors performed argon laser trabeculoplasties using the argon laser Argus (Aesculap Meditec, EC). RESULTS: Two months after treatment mean IOP reduction from baseline was 1.9 mmHg or, respectively, 8.8 % after SLT with the SLT-System I, 2.0 mmHg or, respectively, 9.5 % after SLT with SLT-System II, and 2.2 mmHg or, respectively, 9.9 % after ALT with the argon laser. Twelve months after LTP mean pressure reductions were 1.7 mmHg (7.9 %) after SLT-I, 1.8 mmHg (8.5 %) after SLT-II, and 2.1 mmHg (9.4 %) after ALT. The response curve of the eyes with SLT-I greatly resembled that of the eyes with SLT-II and those eyes with ALT. CONCLUSIONS: Pressure reduction was highest after ALT, followed by SLT-II, in SLT-I reduction was the least, but the differences were not significant. Our findings did not correspond with those of other authors reporting an average IOP reduction of 25 % after SLT and ALT. SLT has shown reasonable efficacy in lowering IOP in eyes with ocular hypertension and primary open angle glaucoma, SLT achieves about the same level of IOP reduction compared with ALT. As a result of the preservation of the structure of the trabecular meshwork and low rate of complications, SLT is a safe alternative to ALT. The exact biological effect induced with SLT is still not yet understood. For the early glaucoma stages SLT provides an alternative to drug treatment, for the advanced glaucomas SLT is an additional option for further pressure reduction. More long-term follow-up studies are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT.     

Evaluating selective laser trabeculoplasty versus argon laser trabeculoplasty in pseudoexfoliation glaucoma patients

Objective

Laser trabeculoplasty effectively reduces intraocular pressure (IOP) in primary open angle glaucoma, with argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) showing equivalent outcomes. However, it is unclear which laser modality is more effective in pseudoexfoliation (PXE) glaucoma. This study aims to compare the effectiveness of ALT and SLT in PXE glaucoma.

选择性激光小梁成形术临床疗效观察

目的:评价选择性激光小梁成形术对进展期青光眼的治疗效果。方法:对26例36眼房角开放的进展期的开角型青光眼和继发性青光眼患者,选用激光小梁成形术进行治疗。测量激光前及激光术后不同时间的眼压并进行统计学分析,观察激光前后视力、眼底、视野和局部用药量的变化。结果:患者术前眼压24.44±5.55mmHg,术后1h为24.22±6.32mmHg,无统计学差异;术后1d;1wk;1,2,3,6,9,12mo眼压下降,与术前有统计学差异(P<0.01)。术前患者杯盘比为0.75±0.16,术后6mo为0.76±0.14,无统计学差异;术后12mo为0.77±0.15,与术前比较有统计学差异(P<0.05)。术前用药平均为1.69±0.58种,术后6mo内用量下降,有统计学差异;9,12mo用药量上升,与术前比较无统计学差异(P<0.05)。视力、视野术前术后无进展。结论:激光小梁成形术可以有效地降低进展期青光眼患者的眼内压。