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。     

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。     

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青光眼的研究进展

青光眼是世界第二位不可逆的致盲性眼病,一旦确诊,需要长期治疗。激光治疗已经成为青光眼治疗的3个主要手段之一,其中选择性激光小梁成形术（SLT）可选择性地作用于色素性小梁组织,使靶组织收缩,房水外流通畅,从而降低青光眼患者的眼压,但其具体作用机制复杂,目前尚不完全明确。由于其对小梁网组织破坏程度轻微,术后反应较轻,且对邻近组织无损伤,因此是一种安全且可重复治疗的手段,并且不会影响青光眼的下一步治疗。就SLT的原理及SLT临床应用的背景、临床疗效、治疗的安全性等进行综述。     

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。     

选择性激光小梁成形术对部分特殊类型高眼压患者的降压效果

目的:探讨选择性激光小梁成形术(selective laser trabecu-loplasty,SLT)对部分特殊类型眼压升高患者的降眼压效果。这些患者不适宜或者不接受抗青光眼手术治疗。方法:临床观察10例高眼压患者,其中硅油取出后无晶状体高眼压1例,青光眼术后3例(其中1例在阿塞拜疆行二次抗青光眼手术),未确诊青光眼的高眼压症3例,硅油充填术后1例,绝对期青光眼2例(其中开角1例,闭角1例),根据眼压范围行Nd:YAG激光SLT治疗(选择上方或下方180°范围内治疗,原发性闭角型青光眼行激光周边虹膜成形术和激光周边虹膜切除术后眼压>21mmHg的再行选择性激光小梁成形术)。结果:SLT10眼术前平均眼压28.9±5.4mmHg(眼压22～40mmHg);术后1d;1wk;1,6mo眼压分别为21.6±6.5mmHg,24.3±6.01mmHg,22.2±63mmHg,21.4±5.2mmHg。SLT术后6mo不用药物眼压≤21mmHg有6眼;部分患者需要重复治疗,全部患者加用1种降眼压药物眼压≤21mmHg,未出现明显的前房炎症反应,少部分患者在治疗时有轻微的疼痛及不适感。结论:SLT对于不适宜抗青光眼手术治疗的一些特殊类型的高眼压患者,是安全有效、费用低廉的可供选择的降眼压方法。     

多次半周选择性激光小梁成形术治疗原发性开角型青光眼

目的探讨应用半周选择性激光小梁成形术(SLT)多次治疗原发性开角型青光眼(POAG)的疗效。方法应用半周SLT治疗POAG首次治疗失败者22例(24只眼),采用532 nm倍频Q-开关Nd:YAG激光治疗仪,以光斑400μm,脉冲时间3ns,能量0.8～1.2 mJ行第2次、第3次半周SLT。观察治疗后眼压、视力、前房反应等。结果 21例(22只眼)18个月眼压平均下降(5.2±2.1)mm Hg,无明显不良反应。结论对于已行SLT控制眼压失败的患者可再行SLT,疗效良好。     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Effects of Adenosine Agonists on Intraocular Pressure and Aqueous Humor Dynamics in Cynomolgus Monkeys

The effects of single or multiple topical doses of the relatively selective A₁adenosine receptor agonists (R)-phenylisopropyladenosine (R-PIA) and N⁶-cyclohexyladenosine (CHA) on intraocular pressure (IOP), aqueous humor flow (AHF) and outflow facility were investigated in ocular normotensive cynomolgus monkeys. IOP and AHF were determined, under ketamine anesthesia, by Goldmann applanation tonometry and fluorophotometry, respectively. Total outflow facility was determined by anterior chamber perfusion under pentobarbital anesthesia. A single unilateral topical application of R-PIA (20–250 μg) or CHA (20–500 μg) produced ocular hypertension (maximum rise=4.9 or 3.5 mmHg) within 30 min, followed by ocular hypotension (maximum fall=2.1 or 3.6 mmHg) from 2–6 hr. The relatively selective adenosine A₂antagonist 3,7-dimethyl-1-propargylxanthine (DMPX, 320 μg) inhibited the early hypertension, without influencing the hypotension. Neither 100 μg R-PIA nor 500 μg CHA clearly altered AHF. Total outflow facility was increased by 71% 3 hr after 100 μg R-PIA. In conclusion, the early ocular hypertension produced by topical adenosine agonists in cynomolgus monkeys is associated with the activation of adenosine A₂receptors, while the subsequent hypotension appears to be mediated by adenosine A₁receptors and results primarily from increased outflow facility.