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

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.     

选择性激光小梁成形术治疗开角型青光眼的研究进展

激光用于青光眼的治疗已有近35a的历史。近年来,选择性激光小梁成形术(SLT)以其安全、有效降眼压、并发症少等优点逐渐成为开角型青光眼的首选治疗。选择性激光小梁成形术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。与氩激光小梁成形术(argonlasertrabeculoplasty,ALT)相比,两者降眼压效果相似,但是相对于ALT对小梁网的凝固性损伤,SLT选择性作用于色素性小梁细胞,无凝固性损伤,对小梁网组织轻微破坏,是一种安全且可重复治疗的手段。     

Mid-term results of patterned laser trabeculoplasty for uncontrolled ocular hypertension and primary open angle glaucoma

AIM: To describe the safety and efficacy of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in primary open angle glaucoma (POAG) and ocular hypertension (OHT) after 18-month follow-up in Hispanic population.METHODS: A single-center, retrospective study was conducted. All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study. Investigated parameters were intraocular pressure (IOP), the number of IOP-lowering medications, best corrected visual acuity (BCVA), laser parameters and postoperative adverse events. Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction ≥20% at 18mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values.RESULTS: From 40 PLT-treated eyes (mean baseline IOP 20.3±1.7 mm Hg), 24 patients were analyzed (age 63.4±7.3y). The mean IOP reductions from baseline across visits (months 1, 3, 6, 9, 12, and 18) ranged from 14.1% to 20.8%. Success rate after 18-month follow-up was 61.7% with a mean IOP of 16±3.2 mm Hg (P<0.001). The number of glaucoma IOP-lowering medications per eye (preoperative 2.1±1.1 and postoperative 2.3±1.1, P=0.86) and the mean BCVA (preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR, P=0.42) remained stable. Adverse events comprised transitory IOP spikes in 4 eyes (10%) and peripheral anterior synechiae in 7 eyes (17.5%).CONCLUSION: Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.     

Clinical outcomes of patterned laser trabeculoplasty as adjuvant therapy in open angle glaucoma and ocular hypertension

AIM: To assess the efficacy and safety of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in open angle glaucoma (OAG) or ocular hypertension (OHT) patients who were under antiglaucoma medical treatment. METHODS: This study was a retrospective review of primary or secondary OAG patients and OHT patients with medically uncontrolled (≥18 mm Hg) intraocular pressure (IOP) who underwent 360o PLT from June 2016 to August 2016. Follow-up visits at week 1, and 1, 3 and 6mo were performed. IOP, best corrected visual acuity (BCVA), complications and eye drop glaucoma medication were recorded at each follow-up visit. Success was defined as IOP reduction ≥20% from baseline. RESULTS: Forty-one eyes of 25 patients were included in this study. Pre-treatment mean IOP was 20.2±1.6 mm Hg. After PLT, IOP was 19.3±5.2, 16.1±2.7, 17.1±3.7 and 16.3±3.5 mm Hg, at 1wk, 1, 3 and 6mo, respectively. IOP reduction from baseline was statistically significant from the first month, remaining stable at 6mo (P<0.001). PLT success at 6mo of follow-up was 48.78%. The number of glaucoma medication per eye (P=0.10) and the mean BCVA both remained constant (P=0.37). Complications included transient IOP spikes in 4 eyes (9.8%) and peripheral anterior synechiae in 7 eyes (17.1%). CONCLUSION: PLT is an effective and safe method for the management of patients with OHT or OAG as an adjunctive therapy. Additional larger studies should be designed to verify the long-term stability of IOP reduction with this laser technology.     

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对高眼压症的临床疗效观察

目的:评价选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗高眼压症(ocular hypertention,OH)的治疗效果。方法:诊断为OH患者28例(28眼,男15例,女13例),平均年龄31.4±11.0岁;术前眼压29.11±4.94mmHg。所有患者上方房角180°范围内进行治疗,能量0.85～1.56mJ,点数80～120点。测量术后1,2,3,4h眼压,术后1d;1wk;1,3,6mo;1a随访,监测术后眼压、视力、视野、杯盘比变化。结果:患者术前平均眼压29.33±4.17mmHg,术后1d为18.73±5.70mmHg、于术后1d停用药物治疗,其后随访的眼压结果:1wk为22.39±4.36mmHg,1mo为20.92±3.74mmHg,3mo为23.05±3.06mmHg,6mo为23.54±3.12mmHg,1a为24.68±2.57mmHg。术前患者杯盘比为0.50±0.19,术后1a为0.51±0.17;术前视力0.82±0.30,术后1a视力0.84±0.43;视野术后无变化。结论:SLT可以有效的降低高眼压症患者的眼内压。     

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.     

180°和360°选择性激光小梁成形术治疗原发性开角型青光眼的疗效比较

目的:评价并比较180°和360°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)的临床效果。方法:POAG患者60例60眼,分别采用532nm倍频Q-开关Nd:YAG激光治疗仪,以光斑400μm,脉冲时间3ns,能量0.3～1.2mJ行180°和360°SLT。观察患者术后6mo的眼压变化。结果:两组患者眼压在激光治疗后均有显著下降,180°组患者术前平均眼压为25.6±2.0mmHg(1kPa=7.5mmHg),术后1h;1d;1wk;1,3,6mo眼压分别为27.1±2.1,16.5±1.9,19.6±1.9,18.5±1.8,19.9±1.9,20.3±1.8mmHg。360°组患者术前平均眼压为25.4±2.1mmHg,术后对应时间点眼压分别为26.6±1.9,15.9±2.0,19.0±2.0,17.8±1.9,18.7±2.0,19.2±1.9mmHg。两组术后1d;1wk;1,3,6mo的眼压与术前相比明显下降,差异均有统计学意义(P<0.01)。术后两组各时间点眼压的平均下降幅度比较,360°组较180°组术后眼压的平均下降幅度更大,其中术后3mo和6mo差异具有统计学意义(P<0.05)。结论:360°SLT治疗POAG的疗效可能优于180°SLT。