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.     

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。     

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     

难治性青光眼半导体激光经巩膜睫状体光凝术

目的　评价半导体激光经巩膜睫状体光凝术治疗难治性青光眼的效果和安全性。方法　 68例 (69眼 )接受治疗 ,术后随访 6～ 17月。分析末次治疗后第 6月的眼压、视力和眼部症状。结果　无光感组 (3 6眼 ) :光凝术前眼压 (61.16± 12 .44 )mmHg(1mmHg =0 .13 3kPa) ,末次光凝术后第 6月后 3 3眼眼压 (2 9.67± 6.79)mmHg。 3眼眼球萎缩 ,12眼需 2次或多次治疗。光感及光感以上组 (3 3眼 ) :光凝术前眼压 (5 1.72± 13 .85 )mmHg ,末次光凝术后第 6月眼压 (2 1.42± 8.2 2 )mmHg。其中 11眼需要 2次或 3次光凝术 ,4眼 3次光凝术后眼压仍高于 2 1mmHg。结论　半导体激光经巩膜睫状体光凝术是一种简单、安全、有效的治疗难治性青光眼的方法 ,但常需要重复治疗。     

二极管激光经巩膜睫状体光凝术治疗难治性青光眼疗效观察

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。方法对2004年1月～2006年收治的难治性青光眼256例(256只眼),采用IRISOculightRSLx810nm红外激光光凝仪,波长810nm,G-ProbeTM探头,进行二极管激光经巩膜睫状体光凝术。睫状体光凝时的功率范围1600～2500mw,时间1500～2000ms。使用G-ProbeTM探头内缘贴紧角膜缘在360°范围内均匀分布,共击射40～80个点。结果术后第1天、1个月、6个月眼压控制成功好转率分别为93.36%、98.43%、99.22%。疼痛缓解率98.43%。视力不变或改善的占96.19%。并发症仅为前房出血和反应性葡萄膜炎。结论二极管激光经巩膜睫状体光凝术具有简单易行、降压迅速、易于操作、耐受性好、患者疼痛小等优点,适当增加治疗点数会明显提高手术成功率,不会导致眼球萎缩。     

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。     

经巩膜睫状体光凝术治疗难治性青光眼初步观察

目的　探讨经巩膜睫状体光凝术治疗难治性青光眼的疗效、方法、术后并发症。方法　 2 4例难治性青光眼中新生血管性青光眼 9例 9只眼 (NVG) ,原发性闭角性青光眼 (绝对期 ) (PACG) 7例 7只眼 ,复杂眼外伤继发青光眼 5例 (5只眼 ) ,PPV手术后及慢性葡萄膜炎继发青光眼 3例 (3只眼 ) ,行经巩膜睫状体光凝术 ,其中 8例 (8只眼 )进行了 2次光凝。结果　 2 4例 (2 4只眼 )治疗前平均眼压 (40 .83± 3.79) m m Hg,光凝后 1周平均眼压 (2 1.76± 9.4 3) mm Hg,两者比较 ,差异有显著意义。 (t=11.0 84 ,P <0 .0 5 ) ,光凝治疗后 1月平均眼压 (2 5 .5 1± 9.8)0 m m Hg,(t=8.2 7,P <0 .0 5 )。术后视功能保持不变 2 3只眼 (96 % )。术后前房出血 2只眼 ,顽固性前房炎症反应1只眼 ,无眼球萎缩病例。结论　睫状体光凝术治疗难治性青光眼疗效可靠 ,但要掌握光凝方法 ,注意治疗并发症。     

半导体激光经巩膜睫状体光凝术治疗难治性青光眼

目的：评价半导体激光经巩膜睫状体光凝术治疗难治性青光眼的临床疗效和安全性。
　　方法：回顾性分析2012－03／2013－03到我院眼科就诊33例33眼难治性青光眼患者临床资料,所有患者均行半导体激光经巩膜睫状体光凝术,激光能量1000～3000 mW,时间2000～3000ms,击射范围270°～360°,击射点20～40点。随访观察并记录患者临床症状、视力、眼压、眼前节及并发症,随访时间为6 mo。
　　结果：最后随访时32例（97％）的患者眼部症状明显缓解或消失;术前平均眼压为50．26±9．37mmHg,最后随访6mo时平均眼压下降为18．38±8．73mmHg,治疗前后眼压具有统计学意义（P＜0．05）。2例（6％）术后3mo时眼压再次升高,给予再次激光治疗,术后并发症为前房炎症反应9例（27％）,前房出血5例（15％）,结膜下出血2例（6％）,结膜充血水肿12例（36％）,眼球萎缩1例（3％）。结论：半导体激光经巩膜睫状体光凝术治疗难治性青光眼是一种简便、降压显著、痛苦小、安全有效的方法。     

二极管激光经巩膜睫状体光凝术治疗先天性小眼球合并青光眼

目的：观察二极管激光经巩膜睫状体光凝术治疗先天性小眼球合并青光眼持续性高眼压的临床效果。 方法：回顾性自身对照研究,收集2009-01/2011-01在邢台眼科医院收治的先天性小眼球继发青光眼持续性高眼压并行二极管激光经巩膜睫状体光凝术的患者5例7眼。观察手术前后视力、眼压、并发症情况,并进行统计学处理。 结果：术后随访期间全部患者眼痛症状均缓解。术前平均眼压为52.56±7.31mmHg,术后1mo平均眼压17.8±47mmHg,6mo随访时平均眼压14.18±4.53mmHg,术后1mo及6mo眼压与术前相比,差异有显著统计学意义(P<0.01)。术后平均视力(0.127±0.165)较术前(0.0334±00322)提高,差异有显著统计学意义(P<0.01)。光凝术后5眼(71.4%)视力提高,2眼(28.6%)视力无变化,术后均有前房炎症反应伴前房渗出,药物治疗后消失。 结论：二极管激光经巩膜睫状体光凝术治疗先天性小眼球合并青光眼持续性高眼压,疗效确切,可降低眼压,缓解疼痛,并发症少。     

经23G微创巩膜切口睫状体光凝术治疗难治性青光眼

目的：观察经23G微创巩膜切口睫状体光凝术治疗难治性青光眼的疗效及其安全性。

方法：对23例23眼难治性青光眼患者采用经23G微创巩膜切口睫状体光凝,观察术后眼压、最佳矫正视力、降眼压药物数量、并发症情况。

结果：手术后眼压、最佳矫正视力及降眼压药物数量与术前相比,差异有统计学意义(P<0.05); 术后并发症少。

结论：经23G微创巩膜切口睫状体光凝术是一种新型且安全有效的治疗难治性青光眼的手术方法。     

半导体激光经巩膜睫状体光凝治疗难治性青光眼

目的     

经巩膜睫状体光凝治疗难治性青光眼的临床观察

目的:评价半导体激光经巩膜睫状体光凝术治疗难治性青光眼的效果。方法:回顾性分析55例56眼难治性青光眼的临床资料,均行睫状体光凝,术后随访观察并记录眼压、视力、眼部自觉症状以及并发症,随访时间3mo以上。结果:术前平均眼压53.5±18.7mmHg,末次随访平均眼压为19.4±9.6mmHg,术后眼压与术前眼压相比,差别具有统计学意义(P<0.01)。术后44眼视力无变化,2眼视力提高,10眼视力下降;眼痛均消失或缓解;并发症少,主要有葡萄膜炎、前房出血等。结论:睫状体光凝能有效降低难治性青光眼患者的眼压,且并发症少。     

半导体激光透巩膜光凝睫状体治疗难治性青光眼

本文评价了非接触性半导体激光透巩膜睫状体光凝治疗青光的疗效。15名患者16只眼,新生血管性青光眼3例,慢闭8例,慢性开角型4例,外伤后继发性青光眼1例。表面麻醉下于角巩缘后1mm光凝360°(,均匀分布光凝点,点数25—110,光斑直径200μm,功率0.75-1W,脉宽3-5s,离焦1.5mm。平均随访时间3月,平均眼压从术前27.1±7.5mmHg下降至19.5±8.4mmHg,平均下降7.6±4.6mmHg。术后眼压下降值与光凝况能量相关,术中12例(75%)光凝颞上象限时有轻至中度疼痛。术后并发症有结膜充血7例(44%),均于1周内消退。1例(6%)术后天疼痛明显,1周后缓解。以上结果表明应表表面麻醉非接触式DCCP是一种简便、易行,有一定疗效的治疗青光眼的方法。     

Diode laser trans-scleral cyclophotocoagulation for glaucoma following silicone oil removal

Purpose : To evaluate the effect of trans‐scleral cyclophotocoagulation (TSCP) on intraocular pressure (IOP) in eyes with medically uncontrolled secondary glaucoma persisting after intravitreal silicone oil removal. Methods : Clinical records of 21 eyes of 21 patients who underwent TSCP for medically uncontrolled glaucoma persisting after the removal of intravitreal silicone oil, injected during vitreoretinal surgery for proliferative vitreoretinopathy (PVR), were reviewed retrospectively. Diode laser contact TSCP was applied at a power setting of 1.5–2.5 W, for a maximum duration of 2 s, and a total of 40 spots (10 spots each quadrant). All the patients were evaluated for visual acuity, IOP and number of medications used. Results : The patients were followed up for a mean ± SD period of 39.9 ± 4.27 weeks (range 36–48 weeks). The IOP was found to have decreased significantly from a pretreatment value of 34.5 ± 5.37 mmHg (range 24–44 mmHg) to 20.47 ± 4.49 mmHg at 6 months of follow up (range 12–30 mmHg, P < 0.01, Student’s paired t‐test). The total number of glaucoma medications being used reduced from 3.38 ± 0.5 to 1.08 ± 0.80 postoperatively (P < 0.01, Wilcoxon’s rank sum test). There was no significant difference in the visual acuity before and after the procedure. Thirteen eyes required a second sitting of TSCP, and five of these required a third sitting. For a successful outcome (IOP < 24 mmHg), a mean of 1.56 sittings (range 1–3 sittings) per eye were needed. Conclusion : Patients with medically uncontrolled glaucoma persisting after intravitreal silicone oil removal can be treated with TSCP; however, the reduction of IOP is variable. The IOP usually falls after a mean of 2–3 sittings of TSCP.     

Diode laser cyclophotocoagulation: Dose-standardized therapy in end-stage glaucoma*

Background: Ciliary body ablation in end-stage glaucoma has been widely performed with cryotherapy and neodymium: yttrium aluminium garnet (Nd: YAG) laser; both techniques frequently involving considerable pain and postoperative inflammation, with an unpredictable final intraocular pressure (IOP) and a significant risk of phthisis. Diode laser cyclophotocoagulation (cyclodiode laser) has recently been introduced in an attempt to avoid some of these problems. Methods: Thirty patients with uncontrolled IOP and advanced glaucoma were divided on clinical grounds into two groups and were treated with either a half or a full standardized dose of laser (40 × 1500 mW for 1500 ms) and monitored for IOP control, visual acuity, postoperative inflammation and phthisis. Success of IOP control was defined as IOP < 22 mmHg or a decrease in IOP of > 30%; preservation of visual acuity or control of pain in blind eyes was also assessed. Results: A sustained lowering of IOP was achieved in 90% of patients, with a mean follow up of 10.4 months. For the full treatment cases (group A), mean (± SD) pre-operative and postoperative IOP was 49.4 ± 11.2 and 25.8 ± 17.7 mmHg, respectively (a 48% reduction); 55% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction of > 30%. For the half-treatment cases (group B), the mean preoperative and postoperative IOP was 29.4 ± 4.3 and 18.9 ± 5.7 mmHg, respectively (a 36% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Neovascular glaucoma was present in 60% of patients; the full-treatment subgroup of these patients achieved a mean lowering of IOP of 58%. Of 22 sighted eyes, 11 (50%) recorded no change in vision; seven (32%) eyes lost and four (18%) eyes gained vision; pain control was achieved in six of eight blind eyes (75%). There was no significant postoperative inflammation, one case of hypotony and no suggestion to date of sympathetic ophthalmia. Conclusion: Diode laser cyclophotocoagulation appears to be simple, safe and is frequently successful in the control of IOP in end-stage glaucoma. Optimum dosage parameters remain to be determined.     

半导体激光透巩膜睫状体光凝治疗新生血管性青光眼

目的　评价利用半导体激光透巩膜睫状体光凝治疗新生血管性青光眼的效果。方法　对 4 2例药物控制不良的新生血管性青光眼患眼进行 810nm半导体激光的透巩膜睫状体光凝 ,能量为 1.5 0～ 2 .2 5W ,时间为 2s,范围 180°～ 2 70° ,观察 6个月的治疗效果。结果　治疗前眼压为 ( 4 5 .3± 3.7)mmHg( 35～ 5 6mmHg ,1kPa =7.5mmHg) ,经过第 1次治疗后的眼压是 ( 18.2± 2 .1)mmHg( 12～ 33mmHg) ,随访最后统计的眼压是 ( 17.6± 1.6 )mmHg( 13～ 2 9mmHg) ,术后眼压明显低于术前 (P <0 .0 5 )。在随访结束时 ,33眼 ( 78.6 % )治疗取得成功。结论　透巩膜半导体激光睫状体光凝是治疗新生血管性青光眼的一种有效的方法 ,而且操作方便 ,患者痛苦小     

Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma

Background: Transscleral diode laser cyclophotocoagulation (TSCPC) is an established method of treatment for refractory glaucoma, but is associated with significant complications. This study evaluates the efficacy and safety of a new form of TSCPC using micropulse diode laser and trans‐pars plana treatment with a novel contact probe. Methods: Prospective interventional case series of 40 eyes of 38 consecutive patients with refractory glaucoma treated with micropulse TSCPC with a novel probe. Outcomes measured were success, hypotony and response rates. Results: The mean age of patients was 63.2 ± 16.0 years. The mean follow‐up period was 16.3 ± 4.5 months. The mean intraocular pressure (IOP) before micropulse TSCPC was 39.3 ± 12.6 mmHg. Mean IOP decreased to 31.1 ± 13.4 mmHg at 1 day, 28.0 ± 12.0 mmHg at 1 week, 27.4 ± 12.7 mmHg at 1 month, 27.1 ± 13.6 mmHg at 3 months, 25.8 ± 14.5 mmHg at 6 months, 26.6 ± 14.7 mmHg at 12 months and 26.2 ± 14.3 mmHg at 18 months (P < 0.001 at all time points). No patient had hypotony or loss of best‐corrected visual acuity. The overall success rate after a mean of 1.3 treatment sessions was 72.7%. Conclusion: Micropulse TSCPC is a safe and effective method of lowering IOP in cases of refractory glaucoma and is comparable with conventional TSCPC.     

Longterm follow‐up of diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma

Purpose: This prospective study was conducted to evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TDLCP) in advanced refractory glaucoma. Methods: A total of 124 eyes in 121 patients with advanced glaucoma refractory to medical treatment were treated consecutively with TDLCP. Success was defined as final intraocular pressure (IOP) of 5?21 mmHg in eyes with visual acuity (VA) of more than hand movements (HM) and relief of pain in eyes with VA of HM or less, including blind eyes. Results: Mean patient age was 65.6 ± 17.1 years (range 14–91 years). Mean follow‐up was 17 ± 14.6 months (range 3–42 months). Mean pretreatment IOP was 29.9 ± 8.4 mmHg (range 17–58 mmHg) and IOP at last follow‐up was 20.8 ± 8 mmHg (range 6–45 mmHg) (p < 0.001). The number of laser applications (mean 9.2 ± 2.8, range 4–15) and maximal laser power (mean 2.01 ± 0.22 mW, range 1.3–3.0 mW) were not associated with lower postoperative IOP. Intraocular pressure of ≤ 21 mmHg was recorded in 63.0% of eyes at the last follow‐up visit. Overall, 28 (21.7%) eyes required at least one retreatment. No phthisis bulbi or persistent hypotonia developed. Conclusions: TDLCP is an effective and safe method for the treatment of advanced refractory glaucoma, although repeated treatments are often necessary.