准分子激光角膜原位磨镶术治疗高度近视合并中高度散光

目的:观察准分子激光原位角膜磨镶术(LASIK)治疗高度近视合并中高度散光的临床疗效。方法:采用准分子激光原位角膜磨镶术治疗43例(79眼)高度近视合并中高度散光患者,屈光度为-6.0～-15.5D,散光为-2.0～-5.0D。结果:术后随访6mo,裸眼视力≥术前矫正视力者占91%,屈光度在±0.75D以内者占86%,残留散光平均为-0.45D。结论:LASIK治疗高度近视伴中高度散光,效果明显,安全可靠。     

LASIK治疗近视散光的临床观察

目的:观察准分子激光原位角膜磨镶术(laser in situ kera-tomileusis,LASIK)治疗近视散光的临床疗效。方法:应用鹰视准分子激光治疗系统对120例234眼近视散光进行LASIK手术治疗。随访12mo,比较手术前后的视力、屈光度、散光及其散光轴位的变化。结果:术后随访12mo,裸眼视力≥术前最佳矫正视力(BCVA)者108例213眼(91%),屈光度在±1.00D以内者112例222眼(94.8%),散光残留平均为-0.52D。结论:LASIK治疗近视散光效果好,稳定性高,安全可靠。     

准分子激光双面切削原位角膜磨镶术矫治后巩膜加固术后的高度近视疗效观察

目的:探讨准分子激光双面原位角膜磨镶术矫治后巩膜加固术后高度近视的有效性。方法:选择18例(36眼)后巩膜加固术后高度近视患者,屈光度数稳定1a以上,行准分子激光双面原位角膜磨镶术,观察其术后视力、屈光度的变化。结果:17例裸眼视力(uncorrectedvisualacuity,UCVA)达到或超过术前最佳矫正视力(bestcorrectedvisualacuity,BCVA),1例术后裸眼视力较术前最佳矫正视力下降1行。近视屈光度由术前-11.58±1.57D减小至术后3mo时-0.51±0.96D。结论:准分子激光双面切削原位角膜磨镶术矫治后巩膜加固术后高度近视具有可预测性、有效性和稳定性。     

角膜地形图引导准分子激光个性化切削手术设计

目的探讨角膜地形图引导准分子激光个性化切削手术设计方案及其可靠性。方法2004年1月至2005年6月应用MEL-70准分子激光及其配套角膜地形图引导个性化切削系统治疗复合近视散光性屈光不正30眼,手术均为准分子激光原位角膜磨镶术。9例17眼为初次手术,均有不对称或不规则角膜散光;11例13眼为二次手术,原角膜瓣制作良好,均有偏心切削或不均匀切削等情况。30眼最佳矫正视力平均1.08±0.21;屈光度:球镜平均(-4.40±1.49)D,柱镜平均(-1.26±0.64)D;无明显非角膜性散光。术后3～5d评价疗效。结果30眼手术均顺利,无术中及术后早期并发症。术后3～5d平均裸眼视力1.02±0.26,平均最佳矫正视力1.23±0.27;主观验光屈光度:球镜平均(0.41±0.50)D(-0.5～1.5D),均不接受柱镜;角膜地形图中央3mm散光平均(0.28±0.21)D(0～0.75)D。结论MEL-70角膜地形图引导准分子激光个性化切削系统成熟可靠,正确设计可较好地矫治伴有复杂角膜屈光情况的屈光不正。     

激光原位角膜镶磨术（Lasik）治疗远视临床观察

目的评价激光原位角膜镶磨术矫治远视的效果.方法20眼.术前屈光度+4.50D～+12.50D,平均+7.26D～±2.20D,激光原位角膜镶磨术中准分子激光角膜切削按Schwind公司设计的远视治疗软件进行.结果术后所有眼的近视力都不同程度提高.13眼(65%)≥0.8,19眼(95%)≥0.5,术后裸眼远视力有所下降.术后6月有16眼(80%)恢复至术前水平,其中7眼(35%)达术前最好矫正视力.术后6月的屈光度,12眼(60%)≤±1.00D,平均0.32±2.35 D.结论激光原位角膜镶磨术治疗远视效果肯定,术后近视力明显改善,但术后远视力有降低的可能.     

角膜地形图引导下准分子激光矫正角膜不规则散光及不对称性散光

目的 探讨角膜地形图引导下准分子激光个性化切削手术矫正角膜不规则散光及不对称性散光的效果和优缺点.方法 应用MEL - 70准分子激光仪及配套TOMEY -Ⅲ角膜地形图引导个性化切削系统进行准分子激光原位角膜磨镶术(LASIK)矫正不对称性或不规则角膜散光复性近视散光58例108眼.其中49例97眼为初次手术;另9例11眼为二次手术,系由不均匀切削、偏心切削或中央岛而形成的不规则散光.术前最佳矫正视力均值0.98±0.32;屈光度:球镜平均(-4.59±1.68)D,柱镜平均(-1.62±0.78)D.结果 108眼手术均顺利完成,无术中或术后并发症.术后角膜地形图显示:角膜中央3 mm切削深度平整、均匀,术后1周平均裸眼视力1.03 ±0.29.屈光度:球镜-0.50～+0.75D,平均(-0.35 ±0.29)D,柱镜0～- 0.75D,平均(-0.38 ±0.24)D.结论 TOMEY -Ⅲ角膜地形图捕捉角膜曲率信息准确,引导准分子激光个性化切削程序设计合理,系统安全可靠.用它来进行个性化LASIK可较为精确地矫正角膜不规则及不对称散光.     

选择不同的准分子激光手术矫治中高度近视散光的效果分析

目的探讨准分子激光原位角膜磨镶术（LASIK）和准分子激光上皮瓣下磨镶术（LASEK）治疗中高度散光的安全性和有效性。方法应用德国Asclepion-MeditecAG公司MEL70G-Scan准分子激光治疗系统对90例（133眼）中高度散光分别选用LASIK或LASEK进行治疗。随访3年以上,观察手术前后的视力、屈光度、散光及其散光轴位的变化。结果术后随访3年以上,裸眼视力≥术前最佳矫正视力者占86.46%,术后残留散光度在±1.00D以内者占90.23%,残留散光平均为-0.57D,两种术式的患者术后散光度均明显下降且均未见术中及术后并发症。结论 LASIK及LASEK手术治疗中高度散光并发症少,手术预测性好,均为安全、有效的屈光手术。     

准分子激光原位角膜磨镶术手术治疗超高度近视合并散光

目的观察准分子激光原位角膜磨镶术（LASIK）治疗超高度近视合并散光的临床效果。方法采用准分子激光原位角膜磨镶术治疗52例（101眼）超高度近视合并散光患者,球镜度-10.00D～-14.00D,散光-0.50～-4.50DC。结果术后1天、1、3、6月裸眼视力与术前预期最佳矫正视力符合率分别为78.2%、85.1%、92.1%、87.1%;术后6个月,实际矫正屈光度与术前预期矫正符合率球镜93.1%、柱镜87.1%。结论LASIK治疗超高度近视合并散光,视力恢复快,安全可靠。     

准分子激光原位角膜磨镶术治疗中高度散光

目的 :探讨准分子激光原位角膜磨镶术 (LASIK)治疗中高度散光的安全性和有效性。方法 :应用德国视明(SCHWIND)公司第六代爱丽丝 (ESIRIS)准分子激光治疗系统对 35例 (4 7眼 )中高度散光进行LASIK手术治疗。随访 9个月 ,观察手术前后的视力、屈光度、散光及其散光轴位的变化。结果 :术后随访 9个月 ,裸眼视力≥术前最佳纠正视力(BCVA)者占 4 6 .8% ,散光度数在± 1.0 0D以内者占 91.5 % ,残留散光平均为 - 0 .5 6D ,散光矫正者占 79.4 %。术前与术后结果行t检验显示 ,二者差异有非常显著性 (P <0 .0 1)。结论 :LASIK治疗中高度散光预测性佳 ,安全可靠。     

LASIK治疗远视疗效分析

目的 探讨准分子激光原位角膜磨镶术治疗远视的临床疗效.方法 对25例48只眼远视患者进行准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK),术前等效球镜屈光度为+1.00-+8.00D(+4.20±2.00)D,术后随访一年.结果 术后第1天.裸眼远视力与术前最佳矫正视力相当或下降≤2行,随时间推移远视力逐渐上升.术后1年,裸眼远视力≤0.5为25例48只眼(100%),裸眼远视力≥1.0为13例26只眼(52.0%),平均裸眼远视力0.85±0.28.裸眼近视力≥0.5为25例48只眼(100%),裸眼近视力≥1.0为19例38只眼(76%),平均裸眼近视力0.90±0.26.术后1年,屈光度-0.50-+0.50D占83.2%,+0.50-+1.00D占12.6%,+1.00-+2.40D占6.6%,平均屈光度(+0.75±1.55)D.术中术后无严重并发症.结论 采用LASIK治疗远视具有良好安全性、有效性和可预测性.     

Recent developments in retinal lasers and delivery systems

Photocoagulation is the standard of care for several ocular disorders and in particular retinal conditions. Technology has offered us newer lasing mediums, wavelengths and delivery systems. Pattern scan laser in proliferative diabetic retinopathy and diabetic macular edema allows laser treatment that is less time consuming and less painful. Now, it is possible to deliver a subthreshold micropulse laser that is above the threshold of biochemical effect but below the threshold of a visible, destructive lesion thereby preventing collateral damage. The advent of solid-state diode yellow laser allows us to treat closer to the fovea, is more effective for vascular structures and offers a more uniform effect in patients with light or irregular fundus pigmentation. Newer retinal photocoagulation options along with their advantages is discussed in this review.     

Ocular effects of various laser wavelengths

Lasers have become an indispensable tool in management of many ocular disorders. This review describes the principles of lasers and the effects various laser modalities and wavelength modalities can produce on ocular structure. Guidelines are provided for appropriate selection of various wavelengths and prevention of complications of the laser treatment.     

Femtosecond laser photodisruption of human trabecular meshwork: an in vitro study

The goal of this in vitro study was to test the feasibility of using femtosecond (fsec) laser pulses to fistulize the human trabecular meshwork (TM), and to determine the minimum exposure time and energy dosage needed to create an ablation channel. Corneo-scleral rims were obtained from tissue used for penetrating keratoplasty. Four millimeter tissue strips hydrated in Optisol-GS were used to create partial thickness fistulas in the human TM by focusing a Ti:Sapphire laser beam (45 fsec, 1 kHz, 800 nm) with various pulse energies (7.2 and 14.4 microJ) and exposure times (0.25, 0.5, 1, and 2 sec) on the inner surface of the TM. Two-photon images of the lesions were obtained with a multiphoton microscope, using an ultrafast Ti:Sapphire light source. In addition, sections of fixed tissue were examined by light microscopy. Diameters and lengths of the lesions were determined from the hematoxylin and eosin (H&E) stained sections, and the collagen structure surrounding the lesion was evaluated from the two-photon images. All selected time points (except for 0.25 sec) and energies achieved the desired photodisruption of the TM. Incisions created with 0.5 sec/14.4 microJ irradiation appeared to be the most suitable because they were able to achieve consistent full thickness trabecular ablation. Incisions created at 1 sec /14.4 microJ/pulse and 2 sec/14.4 microJ/pulse were deeper than those at shorter time points with the same pulse energy. Longer exposure times and higher pulse energies were usually more variable and associated with deeper and larger incisions and slight collateral damage. Our results indicate that, with appropriate exposure time and pulse energy, fsec photodisruption can be employed to create lesions in the human TM without damaging the surrounding tissues. This study demonstrates that fsec laser treatments may have future potential for the surgical treatment of glaucoma.     

氪激光与氩激光光凝治疗糖尿病性黄斑水肿的疗效比较

目的:回顾性分析对比氩激光和氪激光光凝治疗糖尿病性黄斑水肿(DME)的疗效。方法:2003-06/2006-06我们选用98例(154眼)黄斑水肿患者随机分为氪、氩激光治疗组治疗,治疗后随诊3~36(平均17.5)mo。结果:氩激光组黄斑水肿消退21眼,部分消退32眼,不变25眼;氪激光组黄斑水肿消退27眼,部分消退37眼,不变12眼,两组疗效比较差异有统计学意义(P<0.05)。氩激光组视力提高29眼,不变23眼,下降26眼;氪激光组视力提高34眼,不变29眼,下降13眼,两组疗效比较差异有统计学意义(P<0.05)。结论:在治疗条件基本相同的情况下,氩激光和氪激光都能进行有效的糖尿病性黄斑水肿治疗,氪离子激光治疗黄斑水肿更具有优越性。     

FD Nd:YAG激光光凝治疗视网膜裂孔

目的：探讨激光在视网膜裂孔的光凝治疗中的作用，以及视网膜脱离术后行眼底激光光凝治疗对其手术的补充作用和在光凝中的技术问题。方法：对36例视网膜裂孔的患者用FD Nd：YAG(532nm)激光进行视网膜光凝治疗。结果：36眼视网膜裂孔的患者中，治疗有效28眼，占77．8％。结论：用FD Nd：YAG(532nm)激光对视网膜裂孔的患者进行视网膜光凝治疗效果显著。     

Selective laser trabeculoplasty retreatment after prior argon laser trabeculoplasty: 1-year results

BACKGROUND: Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are treatments for open-angle glaucoma. Many patients have previously received ALT but could benefit from further treatment. The purpose of this study was to examine whether SLT provided clinical benefit for patients who had previously received complete argon treatment. METHODS: This was a prospective, partially randomized, comparison study. The study compared the effect after 1 year of SLT in patients with open-angle glaucoma (primary, pigmentary, or pseudoexfoliation) who had previously received 360 degrees of ALT with the effect of laser treatment (ALT or SLT) given for the first time in patients with this condition. Ninety-six subjects were given 180 degrees of laser trabeculoplasty. When both eyes qualified for treatment, the first eye treated was included in the analysis. Twenty-seven subjects were treated with SLT after previously receiving 360 degrees of ALT therapy; the remainder were given their first laser treatment, 30 being randomly assigned by coin toss to receive SLT and 39 to receive ALT. RESULTS: The mean intraocular pressure (IOP) before treatment was 21.5 mm Hg (SLT after ALT), 22.9 mm Hg (SLT), and 22.0 mm Hg (ALT), with no statistical difference among the groups (p > 0.05). The mean IOP at 1 year was 16.7 mm Hg (SLT after ALT), 17.1 mm Hg (SLT), and 16.4 mm Hg (ALT). The IOP for all 3 groups was statistically significantly lower than at baseline (p < 0.001), but there were no differences among the groups in this respect (p > 0.05). At 1 year, the percentage IOP reductions from baseline were 23% (SLT), 19.3% (SLT after ALT), and 24% (ALT). There were no differences among the groups in the number of medications used before the laser, although there was a small but statistically significant decrease in the number of medications used before or after the laser treatment in both the SLT and the SLT after ALT group, but not the ALT group. INTERPRETATION: SLT retreatment can produce a clinically useful decrease in IOP at 1 year, similar to that obtained by ALT, in patients who have had prior argon laser treatment. SLT may be a useful adjunctive therapy when 360 degrees of ALT has already been performed.     

Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review

Purpose

Systemic review to compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect.

Methods

Searches of the following databases were performed: PubMed, Cochrane Central Register of Controlled Trials, Ovid, EMBASE, metaRegister of Controlled Trials, and ClinicalTrials.gov. Only randomised controlled trials (RCTs) published in peer-reviewed journals comparing SLT to other glaucoma treatment options were considered. The main outcome measure was the change in IOP from baseline.

Results

An initial search of PubMed identified 23 RCTs with 17 meeting the inclusion criteria. Nine RCTs compared 180° SLT to 180° argon laser trabeculoplasty (ALT) and one trial compared 360° SLT to 360° ALT, all reporting no difference in terms of IOP reduction from baseline. One RCT reported better outcomes with SLT at 1 year but this effect regressed at 2 years. Three trials compared 360° SLT to medical therapy and found no difference between the two treatment options. One trial found greater IOP reduction with latanoprost vs 90° and 180° SLT, and greater IOP reduction with 180° and 360° SLT versus 90° SLT, however no differences were found between 360° SLT versus latanoprost or 360° vs 180° SLT. Two trials compared 180° SLT to 360° SLT finding no difference in IOP reduction. Two trials compared 180° SLT to 90° SLT, one finding no significant difference and one finding greater IOP reduction with 180° SLT over 90° SLT. One trial compared excimer laser trabeculotomy (ELT) to 180° SLT, finding no differences in IOP reduction up to 3 months follow-up but greater IOP reduction with ELT at time intervals between 9 and 24 months. There were no RCTs identified that compared SLT to surgery.

Conclusion

In terms of the IOP lowering effect, there is no difference between SLT and ALT. Three trials indicate no difference between 360° SLT and medical therapy, with one of the trials indicating greater IOP reduction with latanoprost over 90° and 180° SLT. Three trials indicate no difference between 180° SLT and 360° SLT. It is inconclusive whether 90° is less efficacious than 180° SLT. One trial reports greater IOP reduction with ELT over 180° SLT in the long term.     

糖尿病视网膜病变多点扫描激光治疗的研究现状

糖尿病视网膜病变(diabetic retinopathy,DR)是糖代谢异常导致的眼部严重微血管并发症,是工作人群中首位致盲性眼病。尽管现在有多种方法可以有效治疗DR,如玻璃体腔注药术、光动力疗法(photodynamic therapy,PDT)、玻璃体切割术(pars plana vitrectomy,PPV)等,但激光光凝视网膜仍是目前DR治疗的首选方法。但近年来随着激光技术的发展,传统激光中的单点模式已不能满足临床需要,已逐渐被更安全、更有效、并发症少的多点扫描激光替代。我们就DR的多点扫描激光治疗现状作一综述。     

Terapia láser transescleral de micropulsos en el manejo de los pacientes de glaucoma

ObjectiveTo evaluate the efficacy and safety of MicroPulse® transscleral laser therapy (TLT) in the management of glaucoma patients.MethodsA prospective, interventional, non-comparative case series was conducted in the department of ophthalmology, Ain Shams University Hospital on 61 eyes of 46 patients with various glaucoma types and of severity, ranging from mild to severe. In addition to best-corrected visual acuity (BCVA), intraocular pressure (IOP) and the number of glaucoma medications were recorded before and after treatment, along with the postoperative need for systemic carbonic anhydrase inhibitors (CAI), success rates, number of treatment sessions and postoperative complications. Success was defined as an IOP of 6-18 mmHg or at least a 30% decrease from preoperative IOP in the absence of any vision-threatening complications during the 6-month follow-up period.ResultsMicroPulse TLT was performed on 61 glaucomatous eyes. Eleven of the 61 eyes (18%) that did not achieve IOP between 6-18 mmHg, or at least a 30% decrease from baseline at 6 months, had a repeat MicroPulse TLT session.At 6 months follow-up post a single MicroPulse TLT session, the mean IOP reduction was 35.9 ± 14.2%; and 6 months after the second session, it was 36.2 ± 17.5% (P < .001). The success rate after the first session was 73.8% which increased to 78.7% after the second session. The mean anterior chamber (AC) cell reaction was + 1.9 ± .8 at 1 day, + 1.0 ± .7 at 1 week, and + .2 ± .4 at 1 month postoperatively. No cells were detected in any of the cases at 3 and 6 months follow-up (P < .001). The average number of anti-glaucoma eye drops before MicroPulse TLT was 2.6 ± 1.0. Postintervention, the average number of anti-glaucoma eye drops was 1.7 ± 1.2, and sustained at 6 months follow-up after the last treatment session (P < .001). There were no significant complications were noted. One eye developed transient hypotony for 3 months after MicroPulse TLT.ConclusionsMicroPulse TLT is safe and effective in lowering IOP in a variety of glaucoma types and severity.