选择性激光小梁成形术治疗原发性开角型青光眼

目的:选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗原发性开角型青光眼(primary open angle glaucoma,POAG)观察。方法:原发性开角型青光眼80例160眼,蓝黄视野检查未见明显损害或轻度损害,眼压>30mmHg者20例40眼,眼压<30mmHg者60例120眼。使用倍频Q开关,波长532nm,Nd∶YAG激光,照射180°~360°小梁网,光斑400nm,脉宽3μs,能量设置0.3~1.0mJ。光斑点数50~80点,术后1d;1wk;1,3,6mo测眼压。结果:对于眼压在>30mmHg的POAG患者眼压控制不理想。眼压<30mmHg的POAG患者效果明显。结论:SLT的降眼压效果,虽然针对性较强,适宜患者人群窄,但给POAG的治疗提供了新思路和新希望。     

选择性激光小梁成形术治疗原发性开角型青光眼

目的观察选择性激光小梁成形术（select laser trabecularplasty，SLT）治疗原发性开角型青光眼（primary open angle glaucome，POAG）的降压效果。方法对10例16眼POAG患者采用科医人公司生产的Selecta Duet激光机进行治疗。结果16眼治疗前基线眼压平均为30．93mmHg，SLT术后1周眼压平均下降5．8mmHg，2周眼压平均下降5．4mmHg，1个月眼压平均下降6．2mmHg，3个月眼压平均下降5．2mmHg，6个月眼压平均下降5．1mmHg。其中2例3眼停用降眼压药，对2例4眼眼压忽高忽低的患者，重复治疗3次，眼压水平仍偏高，建议手术治疗。结论SLT降压效果是肯定而安全的，对中等眼压水平以下的POAG短期治疗效果是满意的，对一次治疗效果差的患者可重复治疗。     

选择性激光小梁成形术治疗原发性开角型青光眼观察

目的 观察选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)的有效性和安全性.方法 原发性开角型青光眼患者23例36只眼,原发性开角型青光眼小梁切除术后高眼压患者6例6只眼,眼压(25.15±8.23)mmHg,倍频Q-开关532nmNd:YAG激光,单脉冲,脉冲时间3ns,光斑直径400um.应用房角镜鼻侧或颞侧房角180°范围内进行治疗,能量0.60～1.50mJ,点数(50±5)点.测量术后第1h眼压,术后1d,1周,2周,3周,1月,3月,6月,1年随访,对比术前术后眼压、最佳矫正视力、视野及杯盘比变化.结果 患者术前眼压(25.15±8.23)mmHg,术后1h为(18.14±5.36)mmHg,1d为(14.52±3.63)月mmHg,1周为(18.12±2.38)mmHg,1月为(17.96±3.35)mmHg,3月为(18.05±2.58)mmHg,6月为(17.48±2.12)mmHg,1年为(17.89±3.13)mmHg;术前患者杯盘比为0.65±0.30,术后1年为0.63±0.20;术前视力0.60±0.30,术后1年视力0.61±0.32;视野术前术后无变化.结论 选择性激光小梁成形术可以有效地降低原发性开角型青光眼及原发性开角型青光眼小梁切除术后高眼压患者的眼内压.

Abstract：

Objective To evaluate the efficiency and safety of selective laser trabeculoplasty (SLT) on primary open angle glaucoma (POAG). Methods A total of 36 eyes of 23 patients with POAG, 6 eyes of 6POAG patients with high intraocular pressure (IOP) after SLT therapy, IOP (25.15± 8.23) mmHg, and they were treated with a frequency-doubled, Q-switched Nd:YAG laser (532nm). A total of approximately 50± 5nonoverlaping spots were placed over 180° of the gonioscope nasal or temporal side at the energy levels ranging from 0.60-1.50m J/pulses. Every patient was asked for follow-up at 1h, 1d, 1w, 2w, 3w, 1m, 3m, 6m and 1yafter treatment. IOP, visual acuity, C/D and visual field were examined each time. Results The pretreatment IOP was (25.15± 8.23) mmHg. At the end of first 1h, 1d, 1w, 1m, 6m, 1y of the follow-up, the IOP was (18.14± 5.36)mmHg, (14.52± 3.63)mmHg, (17.96± 3.35)mmHg, (18.05± 2.58)mmHg, (17.48± 2.12)mmHg, (17.89± 3.13) mmHg respectively. The pretreatment cup/disc ratio was 0.65± 0.30, at the end of 1y of the follow-up, the C/D ratio was 0.63± 0.20; the pretreatment visual acuity was 0.60± 0.30, at the end of 1y of the follow-up, the visual was 0.61± 0.32, without significant difference in visual field. Conclusions SLT is a kind of effective method to treat POAG and special patients with high intraocular pressure after SLT therapy.     

选择性激光小梁成形术治疗原发性开角型青光眼

目的评价选择性小梁激光成形术（SLT）治疗各类原发性开角性青光眼（POAG）的疗效观察。方法79例（93眼）根据种族的不同（小梁Seheie色素分级）、年龄及眼压情况分为3组,采用国通公司倍频Q-开关。532nmND：YAG激光器,单脉冲,时间为3ns,波长532nm,光斑直径400μm,脉冲能量设置0．4～1．6mJ。术前在盐酸奥布卡因表麻下放置前房角镜,瞄准功能小梁网,选择相应的脉冲能量、象限范围和激光点数进行治疗或重复治疗。术后随访眼压（1h、1d、1周、1个月、3个月、6个月、1年）、眼底及视野。结果3个组79例（93眼）术前1年平均眼压依次为（23．1±6．3）mmHg、（26．52±6．1）mmHg和（29．52±6．1）mmHg;术后1年眼压依次为（12．52±4．3）mmHg、（15．58±4．7）mmHg和（16．65±4．5）mmHg。术前与术后眼压相比有显著下降（P〈0．01）。3个组眼底C／D比,术前为0．50～0．70±0．15～0．13;术后为0．57～0．68±0．16～0．42。视力：术前0．85～0．57±0．32～0．29;术后0．91～0．58±0．30～0．27,两者比较其差异均无统计学意义。结论SLT对各类POAG均有显著降压作用。     

选择性激光小梁成形术治疗原发性开角型青光眼的临床观察

目的:评价选择性激光小梁成形术(selective laser trabecu-loplasty,SLT)治疗原发性开角型青光眼的疗效和安全性及对不同条件原发性开角型青光眼治疗效果的差异。方法:原发性开角型青光眼46例46眼,分为A组(曾行小梁切除手术)21眼,B组(单纯药物治疗)14眼,C组(诊断未经治疗)11眼,经SLT治疗,随诊6mo,观察眼压、视力、视野等改变。结果:总体平均眼压在术后1d;1wk;1,3和6mo分别为(16.9±3.2),(18.7±3.3),(18.9±3.3),(19.8±3.2),(20.0±3.4)mmHg,均比术前眼压下降,具有显著性统计学差异,同一时间3组间比较无差异,术后反应均为一过性,1～3d内消失。结论:SLT治疗不同条件的原发性开角型青光眼均安全有效,长期疗效及重复治疗有待进一步观察。     

选择性激光小梁成形治疗开角型青光眼的疗效分析

目的 评价选择性激光小梁成形术治疗原发性开角型青光眼的疗效和安全性.方法 局部用药治疗的原发性开角型青光眼43只眼和高眼压症7只眼.使用Q开关倍频Nd:YAG激光实施180°小梁网激光照射.激光能量0.5～1.0 mJ,50～60个击射点.术后定期测量眼压和裂隙灯检查.随访期内仍然给予降眼压眼液.结果 平均随访8.6月(6～12月).术后所眼都有轻度前节炎症反应,3天后自然消退.术后继续使用降眼压眼液.A组(基线眼压17～24 mm Hg)和B组(基线眼压26～36 mm Hg)术后1、3、6、12月眼压下降幅度分别为30.1%、26.3%、25.6%、23.3%;和17%、21.5%、15%、10.9%,2组差异有显著性(P＜0.05).结论 SLT治疗开角青光眼的并发症是轻微的,降眼压的效果与术前眼压基线高低有关.

Abstract：

Objective To investigate the safety and efficacy of selective laser trabeculoplasty (SLT) in the treatment of open angle glaucoma.Methods Forty-three eyes with open-angle glaucoma and 7 eyes with ocular hypertension were treated withafrequency doubled Q-switched Nd:YAG laser.A total of 50～60 laser spots were placed over 180° of trabecular meshwork with energy levels ranging from 0.5 to 1.0mJ per pulse. Intraocular pressure measurement and slit lamp examination were regularly performed after laser surgery. Topical anti-glaucoma drug was given during the follow up period Results The follow up was 6～12 months (average 8.6 months). Slight inflammation of anterior chamber occurred in the all eyes, and disappeared 3 days later automatically. IOP reduction of group A (baseline IOP 17～24 mmHg) and groupB(baseline IOP 26-36 mmHg) was 30.1%, 26.3%, 25.6%,23.3%; and 17%, 21.5%. 15%, 10.9% at 1,3,6and 12 months, respectively. IOP reduction between two groups was significantly difference(P＜0.05). Conclusions Adverse effects of SLT for open angle glaucoma is a mild and temporary. Effect of lowing IOP isrelated to baseline pressure.     

选择性激光小梁成形术治疗不同分期原发性开角型青光眼的疗效观察

目的：评价并比较选择性激光小梁成形术(SLT)治疗不同分期原发性开角型青光眼(POAG)的临床效果。

方法：回顾性研究。选取2018-07/2020-03在我院选择行SLT治疗POAG患者27例51眼,按照视野平均缺损(MD)将患者分三组：早期组(MD>-6dB)15眼,中期组(-12dB≤MD≤-6dB)15眼,晚期组(MD<-12dB)21眼,采用532nm倍频Q开关Nd：YAG激光治疗仪,脉冲时间3ns,光斑直径400μm,行360° SLT治疗,观察治疗后1h,1d,1、3、6、12mo眼压下降比例,观察视野指数(VFI)及MD变化、用药变化、不良反应及治疗有效率。

结果：治疗后12mo内,三组患者眼压及眼压下降比例组间比较均无差异(均P>0.05),各组间VFI及MD有差异(P<0.001),随观察时间延长,各组VFI及MD均未见明显下降(P>0.05)。三组患者治疗有效率在治疗后1、3、6、12mo分别为早期组(100%、93%、87%、67%),中期组(87%、80%、93%、60%),晚期组(67%、71%、62%、19%)。

结论：SLT对早期组、中期组、晚期组POAG患者均可实现有效治疗,但治疗有效率随着时间延长而降低。     

选择性激光小梁成形术对开角型青光眼小梁切除术后高眼压的疗效

目的观察选择性激光小梁成形术对降低开角型青光眼小梁切除术后患者眼压的疗效。方法22例患者22眼,使用倍频Q-开关Nd:YAG激光照射鼻侧180°小梁网,光斑400μm,脉宽3ns,能量设置(0.4～1.0)mJ,光斑点数50～55。术后测1h、1d、1w、1m、3m、6m眼压。结果术后6月成功率为16/22(72.7%)。术前、术后1h、1d、1w、1m、3m、6m眼压分别为23.5±3.4mmHg,24.14±4.3mmHg,16.84±4.6mmHg,19.3±3.8mmHg,18.5±4.1mmHg,19.7±4.5mmHg,19.4±4.7mmHg。结论SLT对开角型青光眼术后高眼压具有良好的降压效果。     

选择性激光小梁成形术对开角型青光眼小梁切除术后高眼压的疗效

目的观察选择性激光小梁成形术对降低开角型青光眼小梁切除术后患者眼压的疗效。方法22例患者22眼,使用倍频Q-开关Nd:YAG激光照射鼻侧180°小梁网,光斑400μm,脉宽3ns,能量设置0.4~1.0mJ,光斑点数50~55。术后测1h、1d、1周及1、3、6月眼压。结果术后6月成功率为16/22(72.7%)。术前、术后1h、1d、1周及1、3、6月眼压分别为(23.5±3.4)mmHg、(24.1±4.3)mmHg、(16.8±4.6)mmHg、(19.3±3.8)mmHg、(18.5±4.1)mmHg、(19.7±4.5)mmHg、(19.4±4.7)mmHg。结论SLT对开角型青光眼术后高眼压具有良好的降压效果。     

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     

Intraocular pressure the day of argon laser trabeculoplasty in primary open-angle glaucoma

Argon laser trabeculoplasty was performed in one eye of 57 phakic patients with primary open-angle glaucoma. The eyes received a mean of 78 +/- 7 treatments over 360 degrees to the anterior trabecular meshwork. The power was titrated to produce blanching without bubble formation. Increased intraocular pressure (range +1 to +22 mmHg) occurred in 30 of the 57 (53%) eyes 1 hour after treatment. Eight (14%) of these eyes had a clinically significant elevation defined by all of three criteria: (1) an intraocular pressure greater than 30 mmHg, (2) greater than a 30% increase over the mean prelaser intraocular pressure, and (3) greater than a 10 mmHg increase over the peak prelaser diurnal intraocular pressure curve. These eight patients received either oral glycerine or acetazolamide. A rebound increase in intraocular pressure requiring repeat medical treatment occurred in four of the eight eyes. Two additional eyes without a pressure elevation 1 hour after treatment showed a later elevation. This was first detected 4 hours postoperatively in one eye and 7 hours after treatment in another eye. The 1-hour postoperative measurement detected most patients with clinically significant increased intraocular pressure (8 of 10 eyes) but these required continued observation for rebound increases. Patients with advanced glaucomatous visual field loss should also be followed closely to detect late increases in intraocular pressure (2 of 10 eyes).     

选择性激光小梁成形术治疗原发性开角型青光眼的一年疗效观察

目的研究选择性激光小梁成形术(SLT)治疗原发性开角型青光眼的安全性和有效性。设计回顾性病例系列。研究对象47例62眼早期原发性开角性青光眼患者。方法所有患者应用Q开关、倍频532 nm、Nd:YAG激光器(Selecta Duet型)行SLT治疗,范围下方房角180度,50个点,单脉冲能量0．5～1．4mJ。激光手术前后抗青光眼药物保持不变。随访12个月。主要指标眼压与并发症。结果在62眼中有72．5%眼压控制。SLT术前平均眼压(24．3±3．7)mmHg,手术后12个月的平均眼压(19．1±3．9)mmHg,眼压的下降差异有统计学意义(P＜0．001)。所有病例在手术后1小时均出现轻度前房炎症反应,3天后消失。结论SLT治疗早期原发性开角型青光眼随访一年是安全有效的。(眼科,2007,16:37-39)     

A review of argon and selective laser trabeculoplasty as primary treatments of open-angle glaucoma

It is generally accepted within the ophthalmic community that medical therapy is the preferred primary treatment in open-angle glaucoma, followed by laser trabeculoplasty if the medical therapy is unsuccessful, with surgery employed more as an end-stage option when these avenues have been exhausted. This review discusses the efficacy of argon laser trabeculoplasty, alone and in comparison with medical therapy as a primary treatment of glaucoma. It will also discuss the new laser technique, selective laser trabeculoplasty.     

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.     

The effect of argon laser trabeculoplasty on the medical control of primary open-angle glaucoma

Argon laser trabeculoplasty was performed in 33 eyes with primary open-angle glaucoma whose intraocular pressures were poorly controlled on medical therapy. Five eyes (three patients) were failures and underwent trabeculectomy within three months. The remaining 28 eyes were followed up for 18 months and received a complete examination at periodic intervals. Beginning three months after trabeculoplasty, an attempt was made to decrease medications in a prospective manner in order to determine the least treatment required to maintain a pressure of less than 22 mmHg. No medication could be discontinued in 39% of eyes, whereas 18% were "cured" by trabeculoplasty and required no further medical therapy for control. Nine of 14 eyes that had been treated with carbonic anhydrase inhibitors were controlled without these drugs after trabeculoplasty. In 57% of eyes, the miotic could be discontinued. A total of 82% of cases still required some medication for pressure control after laser trabeculoplasty.     

选择性激光小梁成形术治疗原发性青光眼

目的评价选择性激光小梁成形术治疗原发性开角型青光眼(primaryopenangleglaucome,POAG)及原发性闭角型青光眼(prionaryangleclosureglaucome,PACG)虹膜周切术后残余青光眼的疗效和安全性。方法前瞻性、非随机性选择局部用药眼压不能控制的原发性开角型青光眼患者(13例16眼),或已行周边虹膜切除或激光虹膜打孔术,房角大部开放而眼压高的原发性闭角型青光眼患者(22例32眼)。应用选择性激光小梁成形术治疗。观察患者术后6个月眼压的变化。结果两组患者的眼压在激光治疗后均有显著下降:POAG组由术前的(25.3±3.9)mmHg降低至术后6个月的(18.0±4.2)mmHg;PACG组由术前的(23.9±3.0)mmHg,降低至术后6个月的(18.8±3.8)mmHg(1kPa=7.5mmHg)。术后暂时的眼压升高为最常见的并发症。结论选择性激光小梁成形术不仅可用于原发性开角型青光眼的治疗,也可以作为治疗残余闭角型青光眼的一种安全有效的方法。     

选择性激光小梁成形术治疗各类型开角型青光眼临床疗效的研究

目的观察选择性激光小梁成形术(selectlasertrabecularplasty,SLT)治疗各类型开角型青光眼(openangleglaucoma,OAG)降低眼内压的临床疗效和临床反应。方法对27例(52眼)多种类型开角型青光眼进行SLT治疗。所用设备为CoherentSelecta7000倍频Q-开关NdYAG双频激光仪。80个非重叠激光斑打击在颞侧180°范围小梁网,能量0.4～1.0mJ,激光斑400μm。术后观察眼内压和前房反应,时间为1d,1,6mo,1a。全部患者定期检查视力、裂隙灯、眼底镜、房角镜、视野(Octopus视野仪)、海德堡共焦激光断层扫描仪,(HRT-ⅡONH)和眼前节生物超声(UBM)检查。结果患者术前眼压平均(26.87±2.6)mmHg,不同时期的眼压大部分改善,术后1a为(20.21±3.4)mmHg,下降幅度为(6.66±2.8)mmHg,相当于下降24.78%,有3眼为高眼压症,没有明显降压效果出现。2眼为发育性青光眼,术后5d内降眼压效果明显,但10d左右眼压回升到接近术前水平转为手术治疗。部分病例仍需配合局部降眼压药。视力、C/D比、房角镜无明显改变。1a视野检查,9眼有改善。结论SLT治疗多种类型开角型青光眼安全有效,没有明显副作用和并发症,是治疗开角型青光眼的有效方法之一。     

真空小梁成形术治疗原发性开角型青光眼

目的初步观察真空小梁成形术(pneumatic trabeculoplasty,PNT)治疗原发性开角型青光眼的临床效果。方法收集我院2011年1月至11月原发性开角型青光眼患者14例(20眼),均接受PNT治疗,观察PNT治疗前后的视力变化,记录PNT治疗前1h及治疗后1h、1d、7d、14d、30d、45d、60d、90d、120d的眼压情况,观察治疗后1个月、2个月、3个月及4个月眼压得到控制和眼压显著下降的患者数量。随访4个月,比较术前和术后4个月视网膜神经纤维层厚度。结果 PNT治疗前视力为0.76±0.23,治疗后为0.73±0.21,差异无统计学意义(P=0.26)。治疗后各时间点眼压与治疗前比较均明显下降,差异均有统计学意义(均为P<0.05)。治疗后1个月、2个月、3个月及4个月分别有13眼(65%)、12眼(60%)、11眼(55%)和5眼(25%)在减少药物或停用药物的情况下眼压得到控制,分别有17眼(85%)、15眼(75%)、15眼(75%)和11眼(55%)眼压显著下降。PNT治疗前使用药物治疗的患者治疗后所用药物明显减少。治疗后4个月各象限视网膜神经纤维层厚度与术前相比,差异均无统计学意义(均为P>0.05)。结论 PNT治疗原发性开角型青光眼安全有效。     

选择性激光小梁成形术治疗原发性青光眼的疗效

目的 评价选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗原发性开角型青光眼(primary open-angle glaucoma,POAG)和原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)的疗效及安全性.方法 收集我院眼科2007年1月至2008年1月就诊的原发性青光眼患者34例61眼,其中POAG组患者18例34眼,CPACG组患者16例27眼,2组均应用SLT治疗.观察患者术后1 h、1 d、1周、1个月、3个月、6个月的眼压以及术后6个月视力、视野、房角及角膜内皮细胞数等变化.结果 2组患者眼压在激光治疗后均有显著下降,POAG组患者术前平均眼压为(25.2±2.2)mmHg(1 kPa=7.5 mmHg),术后1 h、1 d、1周、1个月、3个月、6个月眼压分别为(28.9±1.3)mmHg、(17.0±1.9)mmHg、(19.9±1.7)mmHg、(20.1±1.8)mmHg、(18.2±2.1)mmHg、(18.0±2.1)mmHg.CPACG组患者术前平均眼压为(24.9±2.1)mmHg,术后对应时间点眼压分别为(29.3±1.6)mmHg、(16.9±2.0)mmHg、(20.3±1.8)mmHg、(19.3±1.9)mmHg、(20.1±2.0)mmHg、(18.9±2.2)mmHg.2组术后1 d、1周、1个月、3个月、6个月的眼压与术前相比明显下降,差异均有统计学意义(P均<0.05).术后1 d眼压下降最明显,术后一过性眼压升高为最常见的并发症.术后6个月2组患者随访视力、前房角、视野、角膜内皮细胞计数与术前比较均无明显变化.结论 SLT可以安全有效地降低POAG和房角大部分开放的CPACG患者的眼压.