二极管激光睫状体光凝对角膜移植术后青光眼的疗效

目的评价接触性二极管激光睫状体光凝(TSCPC)对角膜移植术后难治性青光眼的治疗作用.方法对25例26眼角膜移植术后难治性青光眼进行二极管激光接触性经巩膜睫状体光凝.每个点的治疗功率从1.6W到2.8W,持续时间2秒.初次治疗平均点数27.3±7.2(范围20～35).观察术后抗青光眼药物、IOP、视力、角膜移植片的变化和并发症的发生.平均随访时间13.5±6.7月(范围3～27月).结果9眼(34.6%)进行两次以上TSCPC治疗.治疗前后平均应用抗青光眼药物的种类数分别是2.7和1.9种,治疗后明显降低用药的种类数(P=0.000).治疗前后平均IOP分别是33.6±11.6mmHg(范围1 9～51mmHg)和17.2±6.3mmHg(范围5～36mmHg).IOP平均降低16mmHg,治疗后明显降低IOP(P＜0.001).随访期内有21眼(81%)IOP在6～22mmHg之间.治疗前23眼透明的植片,治疗后7眼(30.5%)出现植片混浊.治疗前后视力变化无统计学上差异(P=0.931).无眼球萎缩,低眼压1眼(3.8%).其他常见的并发症有眼部不适和前房闪辉,多在1周内消失.结论二极管激光接触性TSCPC是一种新的睫状体破坏性手术.它具有简单、有效、安全和重复性好的特性,对角膜移植术后难治性青光眼是一种较好的选择,尤其是药物、滤过性手术、房水引流植入物术等治疗失败不能控制的青光眼和仅仅为了减轻痛苦和保留眼球为目的的青光眼.     

经巩膜睫状体光凝治疗难治性青光眼

目的　评价难治性青光眼行二极管激光巩膜睫状体光凝 (transcleraldiodelasercyclophotocoagulation ,TDLCP)的有效性和安全性。方法　观察 6 6例 6 6眼行TDLCP治疗前后用抗青光眼药物的种类、患者的自觉症状、治疗前后眼压、视力及术后并发症 ,随访 1a。结果　抗青光眼药物种类手术前后分别平均为 2 .6种 (1～ 4种 )和 1.8种 (0～ 3种 ) ,治疗后比治疗前用药明显减少 (P <0 .0 0 1)。术后 5 5例疼痛消失 ,9例疼痛明显减轻 ,2例仍有明显疼痛。治疗前后平均眼压分别为 (35 .2± 7.9)mmHg(18～ 80mmHg) (1kPa =7.5mmHg)及(19.5± 6 .2 )mmHg(4～ 6 8mmHg) ,眼压平均下降 15 .4mmHg ,治疗前后有统计学意义 (P <0 .0 0 1)。术后视力提高10眼 ,视力无变化 4 0眼 ,视力下降 16眼。术后并发症为早期前房炎症反应 4 2眼 ,前房出血 5眼 ,角膜水肿 2 3眼 ,术眼光感丧失 5眼 ,眼球萎缩 3眼。结论　虽然经巩膜睫状体光凝术后会发生前房出血、低眼压、眼球萎缩等并发症 ,但其能显著降低眼压、减少患者痛苦并可减少抗青光眼用药 ,因此仍为目前治疗难治性青光眼的一种有效治疗方法     

半导体二极管激光经巩膜睫状体光凝治疗难治性青光眼

目的：研究二极管激光经巩膜睫状体光凝治疗难治性青光眼的病理变化和观察其临床疗效。方法：1对20只青紫蓝兔施行二极管激光经巩膜睫状体光凝（Transscleral cylophoto-coagulation TSCPC)。术后30分,10天,12周观察并记录眼压,眼前节和眼底情况后摘除眼球作病理检查。2对297例（298眼）难治性青光眼施行TSCPC,术后第1,3天,第3周,第3,6月检查并记录视力,眼压,结膜,角膜,虹膜,前房等情况。结论：TSCPC在术后急性期和后期使睫状体上皮细胞破坏,坏死,从而减少房水生成,临床观察证实TSCPC能显著降低难治性青光眼的眼压,明显缓解疼痛,但也存在少量并发症如眼球萎缩,白内障,前房出血等。     

二极管激光经巩膜睫状体光凝术治疗难治性青光眼

目的:研究二极管激光经巩膜睫状体光凝术治疗难治性青光眼的有效性及激光治疗参数。方法:对我院收治的50例50眼晚期难治性青光眼患者行二极管激光经巩膜睫状体光凝术,记录每位患者所用能量,击射范围,光凝点数,爆破点数,观察患者治疗前后的眼压、眼部症状,视力、裂隙灯观察眼前节的改变和并发症等。结果:术后平均眼压(18.50±2.50)mmHg,术后眼压较术前明显下降(P<0.01)。术后46眼疼痛明显减轻,术前术后眼压差值与击射能量的相关性不高;眼压下降值与击射范围、击射点数呈正相关性,眼压下降值与爆破点数显著相关,呈正相关性。结论:二极管激光经巩膜睫状体光凝术治疗难治性青光眼是一种安全有效的方法,激光治疗参数需根据术前眼压、不同类型青光眼进行设计。     

二极管激光经巩膜睫状体光凝术治疗难治性青光眼

目的 观察二极管激光经巩膜睫状体光凝术治疗难治性青光眼的临床疗效.方法 回顾性分析北京同仁医院2007年9月至2008年8月107例(110眼)难治性晚期青光眼患者临床资料,均行二极管睫状体光凝,分析术后眼压、疼痛感、视力、并发症等情况.结果 术后第1天平均眼压(15.90±12.30)mmHg(1 kPa=7.5 mmHg),术后1周平均眼压(14.70±5.21)mmHg,术后1个月平均眼压(14.02±9.50)mmHg,术后3个月平均眼压(14.51±11.30)mmHg,术前与术后第1天、1周、1个月及3个月眼压差异均有统计学意义(均为P<0.01).术后89眼(80.9%)视力不变,17眼(15.5%)视力下降,4眼(3.6%)视力提高.83.6%的患者眼痛症状明显缓解或消失.术后发生前房渗出12眼(10.9%),前房积血6眼(5.4%),玻璃体积血2眼(1.8%),巩膜溶解2眼(1.8%),巩膜穿孔1眼(0.9%).结论 二极管激光经巩膜睫状体光凝术是治疗难治性晚期青光眼的有效方法,能显著降低眼压,减少患者痛苦,并发症少,可重复治疗.     

二极管激光经巩膜睫状体光凝治疗新生血管性青光眼

目的:评价二极管激光经巩膜睫状体光凝治疗新生血管性青光眼的疗效。方法:对52例诊断为新生血管性青光眼的患者行经巩膜的810nm激光睫状体光凝,能量为1500~3000mW,时间2000ms,范围为24~32点,随访1a,观察其治疗效果。结果:治疗前眼压为(57.78±6.46)mmHg,治疗3d后眼压为(30.8±5.41)mmHg,与治疗前相比,差异显著;随访1a后眼压为(19.44±4.38)mmHg,与治疗前相比,差异显著。所有患者的疼痛均得到缓解或消除。结论:经巩膜睫状体光凝治疗新生血管性青光眼是有效和安全的。     

接触式半导体二极管激光经巩膜睫状体光凝治疗晚期难治性青光眼

接触式半导体二极管激光经巩膜睫状体光凝术(Contact transscleral diode laser cyclophotocoagulation，DLCPC或TSCPC)，是一种新型的睫状体破坏术，应用于难治性青光眼的治疗。本主要介绍了DLCPC的作用机制、手术方法、适应证、并发症及临床疗效。大量临床资料表明，DLCPC相对安全、有效、简便，是一种治疗晚期难治性青光眼的选择性手术。     

二极管激光经巩膜睫状体光凝治疗外伤性青光眼23例疗效观察

目的 探讨经巩膜睫状体光凝治疗外伤性青光眼的临床价值。方法 应用接触式二极管激光对２３例２３眼眼压为２５．８１－８１．６５ｍｍＨｇ的外伤青光眼患者行睫状体光凝术。结果 随访３个月眼压控制良好。结论 二极管激光经巩膜睫状体光凝是治疗外伤性、难治性青光眼的有效、安全的方法。     

二极管激光经巩膜睫状体光凝治疗化学烧伤继发性青光眼的疗效观察

目的观察二极管激光经巩膜睫状体光凝(TDLC)治疗化学烧伤继发性青光眼的疗效。方法回顾分析北京积水潭医院和北京同仁医院联合治疗的化学烧伤继发性青光眼患者12例(12只眼)的临床资料,所有患眼均进行TDLC,术后1周、1个月、3个月、6个月常规复查。分析比较患者TDLC术前和术后最佳矫正视力、眼压、抗青光眼药物的种数,记录TDLC术后并发症。结果 TDLC术前12只眼眼压均高于正常,术后眼压下降者占66.7%,与术前相比较,差异有显著统计学意义。TDLC术前使用抗青光眼药物种数为3.08种,术后末次随访时使用抗青光眼药物种数为3.00种,差异无统计学意义。TDLC术后7只眼最佳矫正视力不变,5只眼视力下降。TDLC术后末次随访未见严重并发症。结论 TDLC对化学烧伤继发性青光眼的眼压控制具有一定效果。     

透巩膜睫状体光凝治疗难治性青光眼的疗效观察

目的 评价半导体激光透巩膜睫状体光凝治疗难治性青光眼的临床疗效.方法 取38只眼难治性青光眼,眼压30.9-66.23mmH,平均(45.1±12.98)mmHg,应用激光能量1500～2500mW,脉冲2s,治疗范围270°-300°,观察术后1d、1周、1和3月时患眼的眼压,疼痛情况和并发症.结果 (1)术后1d眼压9.3-33.1mmHg,平均(24.47±8.51)mmHg,术后1周眼压7.5-32.5mmHg,平均(21.67±7.92)mmHg,术后1月眼压5.8～35.5mmHg,平均为(21.02±10.7)mmHg,术后3月眼压4.2-35.8 mmHg,平均(20.03±9.82)mmHg.术后各时间点眼压与术前眼压配对t检验,t值分别为7.11、10.09、8.82和10.03,均P＜0.0001,差异有统计学意义;(2)术后34只眼(89.47%)疼痛明显缓解;(3)并发症有球结膜灼伤水肿2只眼,前房积血23只眼,葡萄膜炎反应18只眼,角膜上皮脱落2只眼.结论 透巩膜睫状体光凝创伤小,早期治疗效果明显,操作简便,能有效降低眼压,缓解难治性青光眼的疼痛.     

半导体激光经巩膜睫状体光凝术治疗晚期外伤性青光眼

目的 探讨半导体激光睫状体光凝术治疗晚期外伤性青光眼的疗效.方法 67例(67只眼)接受治疗,随防时间≥6月,分析治疗后第6月的眼压、视力和眼部症状.结果 视力无光感或光感的眼(Ⅰ组),光凝术后眼部疼痛消失为成功.Ⅰ组37只眼:1次光凝治疗后21只眼(56.76%)成功,其余16只眼(43.24%)需要经2次或2次以上光凝治疗;17只光感的眼中有9只眼变为无光感,4眼眼球萎缩.视力为手动或优于手动的眼(Ⅱ组),眼压在5～21 mmHg者为成功.Ⅱ组30只眼:1次光凝治疗16只眼,2次或2次以上治疗14只眼;共有22只眼(66.67%)成功,2只眼眼球萎缩,5只眼视力丧失.两组患眼1次光凝治疗,新生血管型与其他类型的外伤性青光眼的成功率差异均无统计学意义.结论 半导体激光经巩膜睫状体光凝术是一种简单、安全、有效的治疗晚期外伤性青光眼的方法,但常需要重复治疗.因术后存在着视力丧失和眼球萎缩的可能.对有视力的眼应慎重使用.     

Long-term results after transscleral diode laser cyclophotocoagulation in refractory posttraumatic glaucoma and glaucoma in aphakia

Purpose To evaluate the long-term effect and safety of transscleral diode laser cyclophotocoagulation (TDLC) in eyes with advanced glaucoma in aphakia and posttraumatic glaucoma. Patients and methods Twenty-one eyes of 21 patients with glaucoma in aphakia and 25 eyes of 25 patients with posttraumatic glaucoma were treated with TDLC between 1996 and 2004. If the intraocular pressure (IOP) remained above 21 mmHg despite medication for more than 4 weeks after TDLC, the procedure was repeated. The IOP, number of medications, visual acuity, complications and need of further surgical intervention were all recorded during the follow-up period. Results Follow-up ranged from 12 to 93 months (mean 42.0 ± 29.2) in glaucoma in aphakia and from 12 to 73 months (mean 33.3 ± 17.4) in posttraumatic glaucoma. TDLC was successful in 48% of aphakic eyes with glaucoma and 40% of eyes with posttraumatic glaucoma. More than one TDLC was performed in 85% of cases of glaucoma in aphakia and 76% of cases of posttraumatic glaucoma). In both groups, TDLC was more effective in older patients than younger patients. Further glaucoma surgeries other than TDLC were performed in 43% of glaucoma in aphakic cases, and 44% of posttraumatic glaucoma cases, within the follow-up period. Loss of any light perception was recorded in two aphakic eyes with glaucoma (9.5%) and three eyes with posttraumatic glaucoma (12%). No hypotonia and no phthisis occurred. Conclusions TDLC is moderately effective in advanced posttraumatic glaucoma and glaucoma in aphakia, more effective in older than younger patients, not influenced by prior other glaucoma surgery, and despite a high re-treatment rate very safe in both groups of glaucoma. For younger patients with severe secondary glaucoma in particular, new treatment strategies are needed. The authors have no proprietary interest in any of the products used in the study. Presented at the 6th International Glaucoma Symposium, Athens, Greece, March 28–31, 2007.     

半导体激光经巩膜睫状体光凝术治疗人工晶状体术后青光眼

目的探讨半导体激光经巩膜睫状体光凝术(DLTSCPC)治疗人工晶状体术后青光眼的疗效。方法对34例(42只眼)人工晶状体植入术后青光眼行DLTSCPC,观察分析术中激光参数,术后眼压、视力及并发症,随访(12.2±3.1)1个月。结果 1次激光治疗18只眼(42.86%)眼压控制,能量(1.64±3.20)w,点数(17.31±1.56)个;2次激光治疗15只眼(35.71%)眼压控制,能量(1.51±3.72)w,点数(11.3±4.75)个,治疗成功率78.57%。眼压由术前(31.43±2.74)mm Hg降至最末次随访(18.23±4.54)mm Hg,手术前后比较差异具有显著统计学意义(t=4.24,P0.01)。术后第1天视力,24只眼降低,11只眼不变,7只眼提高;术后第7天视力,27只眼不变,15只眼提高。术前矫正视力(0.23±0.15),术后最末次随访(0.23±0.24),前后比较差异无统计学意义。并发症主要是术中球结膜、巩膜灼伤和术后早期前房内炎症渗出及出血,经治疗后1周内恢复。无视力丧失、眼球萎缩严重并发症发生。结论 DLTSCPC安全有效、并发症少,按循序渐进、宁少毋过原则,可以应用于具有视功能人工晶状体术后青光眼,能有效降低眼压,不影响视力。     

Transscleral diode laser cyclophotocoagulation as primary and secondary surgical treatment in primary open-angle and pseudoexfoliatve glaucoma

Background Transscleral diode laser cyclophotocoagulation (TDLC) has been used successfully in the treatment of refractive glaucoma. However, little is known about TDLC as a primary or secondary surgical procedure in primary open-angle and pseudoexfoliative glaucoma.Methods In a retrospective chart review we analyzed 90 eyes (48 OD/42 OS) in 90 patients (mean age 75 years, range 60–92 years; 51 men/39 woman) with primary open-angle glaucoma (n=66) and pseudoexfoliative glaucoma (n=24) who consecutively underwent TDLC with a minimum follow-up of 24 months. In 24 eyes (26.7%) TDLC was the primary surgical treatment. Mean energy was 80 J (60–92 J). Success was defined as a final intraocular pressure (IOP) between 4 and 18 mmHg, a minimum IOP reduction of 20% and the absence of major complications.Results The overall success rate was 36.7% after 24 months. A mean of 1.3 procedures was performed per patient. No correlation between age and success rate (p=0.887) or gender and success rate (p=0.895) was seen. There was no significant reduction in antiglaucomatous medication (p=0.208), no significant loss of visual acuity (p=0.324) nor a significant relationship between loss of visual acuity and failure of treatment (p=0.201). In patients with primary open-angle glaucoma the success rate was 40.9% after 24 months; in patients with pseudoexfoliative glaucoma it was 25.0% after 24 months. There was no significant difference between primary open-angle glaucoma and pseudoexfoliative glaucoma (p=0.684). Previous ocular surgery decreased the success probability from 45.8 to 33.3% (p=0.001). Prolonged hypotonia occurred in 1 patient. No phthisis bulbi developed.Conclusions Transscleral diode laser cyclophotocoagulation is an effective and safe method not only in the treatment of refractive glaucoma, but also as a primary surgical procedure in primary open-angle and pseudoexfoliative glaucoma. TDLC may be used more widely in glaucoma therapy, although further long-term studies have to confirm these findings.The findings were presented at the 103rd DOG Congress and the 15th SOE Congress, Berlin, 25 September 2005.The authors have no proprietary interest in any of the products used in the study.     

国产半导体激光对兔睫状体的病理影响

目的：探讨国产半导体激光对兔睫状体的病理学改变。方法：用国产半导体激光对正常兔眼作经巩膜睫状体光凝术后,在光镜,电镜下观察其组织反应,结果：组织病理学检显示光凝处睫状体上皮及间质均出现凝固性坏死,程度与激光击射能量有关,击射区外未发现相似变化,结论：形态学结果提示国产半导体激光对击射区睫状体有破坏作用,对周围组织无影响。     

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。     

穿透性角膜移植术后继发性青光眼的临床分析

目的 探讨穿透性角膜移植术后继发性青光眼的原因及相应处理措施。方法 对１４５０例（１５００只眼）穿透性角膜移植术后患者的资料进行回顾性分析,探讨其中８０例（８０只眼）继发性青光眼的发生原因、时间及原发病的关系,并根据不同发生原因的继发性青光眼分别行药物或的手术治疗。结果 ６３只眼经药物治疗后２或３周眼压恢复正常。１７只眼行抗青光眼手术,其中１３只眼的眼压得到控制,４只眼睛压仍高。结论 穿透性角膜移