Diode laser in secondary glaucoma in children--long-term results

This paper presents effectiveness and safety of transscleral contact cyclophotocoagulation with diode laser (TSCPC) in secondary glaucoma in children. Fifteen eyes of 15 children at the age from 4 to 18 years were examined. Majority of patients was aphakic after congenital and traumatic cataract extraction. Microphtalmus, nystagmus and dysgenesis mesodermalis was observed. Eleven eyes had undergone at least one previous trabeculectomy, 9 eyes -cyclokrioaplication and 4 eyes perforate diathermy. In all patients diode laser transscleral cyclophotocoagulation has been performed. The number of procedures per one eye, intraocular pressure (IOP), visual acuity and complications after TSCPC was estimated. Follow-up ranged from 3 to 5 years, mean 4.13 years. TSCPC was performed once in 3 eyes, twice in 6 eyes, three times in 4 eyes and four times in 2 eyes, mean 2.33 procedures per eye. Before the treatment mean IOP was 34.0 mmHg. Decreasing of IOP was observed in 73.3% of eyes. The final mean postoperative IOP was 20.07 mmHg. Visual acuity before operation ranged from no light perception to 0.0001, mean 0.0081. After TSCPC no light perception was noted in 2 eyes. Visual acuity recovered in 1 eye. Mean Length of the eye globe before treatment was 24.48 mm. No changes of length after cyclophotocoagulation were noted. CONCLUSIONS: cyclophotocoagulation by diode laser is a useful therapy for the treatment of secondary pediatric glaucomas with uncontrolled IOP in the long term.     

Diode laser transscleral cyclophotocoagulation for the treatment of refractory glaucoma after penetrating keratoplasty

PURPOSE: To evaluate the effect and safety of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with refractory glaucoma after penetrating keratoplasty (PK). METHODS: Diode laser TSCPC was performed on 32 eyes of 32 patients with secondary glaucoma after penetrating keratoplasty. The mean follow-up period was 11.4 +/- 3.8 months (range, 6-20 months). The intraocular pressure (IOP), number of glaucoma medications, graft status, side effects, and complications of the procedure were all recorded during the follow-up period. The treatment was considered successful if after one cyclodiode treatment the IOP could be reduced to or below 22 mmHg with or without medication. The success rate of the diode laser treatment was analyzed by the Kaplan-Meier survival analysis method during the 6th and 12th months of the follow-up period and the end of the study. The decrease in drug requirement after laser treatment was analyzed by the Wilcoxon nonparametric test. Statistical significance was set at p < 0.05. RESULTS: During the follow-up period, diode laser TSCPC reduced the IOP significantly. Our cumulative success rate was 56% at the end of the study. Cyclodiode treatment resulted in an IOP less than 22 mmHg in 97% of the eyes on the 6th month and 72% of the eyes on the 12th month with or without medication. The total retreatment rate of the study was 44%. More than one treatment was necessary, 8 times in the 1st month, 9 times in the 3rd month, 5 times in the 6th month and 3 times in the 12th month. The average number of antiglaucomatous drugs used was 2.8 before surgery and 1.2 after the 12th month follow-up period (p < 0.05). No eyes with graft failure after treatment were present. Visual acuity improved (> 2 Snellen lines of acuity) in two eyes and remained the same in the others. No serious side effects such as phthisis bulbi or hypotonia were observed. CONCLUSIONS: Diode laser TSCPC appears to be a safe and effective procedure for the treatment of uncontrolled glaucoma secondary to penetrating keratoplasty.     

难治性青光眼睫状体光凝疗效观察

目的:评价激光经巩膜睫状体光凝术(transscleral cyclo-photocoagulation,TSCPC)治疗难治性青光眼的临床疗效。方法:对36眼难治性青光眼采用低能量1.5~2.1W,多点数10~32的TSCPC,术后随访观察并记录眼压,视力,眼部自觉症状以及并发症,随访时间约3mo。结果:术前平均眼压62.89±17.36mmHg,最后随访平均眼压为21.13±7.06mmHg,经配对资料t检验,术前眼压与术后眼压相比,差别具有统计学意义(P<0.05)。手术有效率83%。指数以上视力10眼中术后6眼视力无变化,4眼视力提高。6眼眼压控制欠佳,行睫状体冷冻手术。术前所有眼痛的患者眼痛均消失或缓解,并发症少,程度轻,主要有色素膜炎,前房出血等,无眼球萎缩发生。结论:TSCPC是难治性青光眼的一种简单安全有效的治疗方法。     

半導體二極管激光经鞏膜睫狀體光凝治瘵難治性青光眼

目的研究二極管激光經鞏膜睫狀體光凝治瘵難治性青光眼的病理變化和觀察其臨床瘵效.方法1.对20只青紫蓝兔施行二极管激光经巩膜睫狀体光凝(Transscleral cylophoto-coagulation TSCPG).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、結膜、角膜、虹膜、前房等情况.結論TSCPC在术后急性期和后期使睫狀体上皮細胞破坏、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,明显緩解疼痛,但也存在少量并发症如眼球萎縮、白内障、前房出血等. 關鍵詞二極管激光睫狀體光凝術青光眼     

Transscleral diode laser contact cyclophotocoagulation in the treatment of different glaucomas,also as primary surgery

PURPOSE: To evaluate the clinical outcome of transscleral cyclophotocoagulation (TSCPC) with the diode laser for different glaucomas, especially as primary surgery. METHODS: A retrospective analysis of 250 TSCPC (193 eyes of 145 patients) with different glaucomas and an average age of 62.6+/-17.1 years. Postoperative follow-up ranged from 6 to 48 months (mean 13.9 months). Most of the patients had primary open-angle glaucoma (POAG) or secondary glaucoma. All eyes were treated with 24-30 spots and 1.4-1.8 W at an exposure time of 2 s using a diode laser with a focussing tip. RESULTS: The mean intraocular pressure (IOP) decreased from 24.6+/-6.7 mmHg before to 19.3+/-5.7 mmHg after operation ( P<0.001). The IOP was successfully controlled (final IOP 10-22 mmHg) in 76.4% of cases after a single or multiple TSCPC treatments. The reductions in maximal IOP and in the number and frequency of administration of antiglaucomatous drugs were also significant ( P<0.001). The best results were obtained among the patients with POAG, in the oldest age group and in those patients without any previous or subsequent glaucoma operations. The proportion of eyes requiring multiple treatments was 21.2%, with an average of 1.3 treatments per eye. There was a complication rate of 14.4%, mostly mild uveitis. Phthisis bulbi occurred in three eyes (1.6%). CONCLUSIONS: TSCPC with the diode laser is a safe, effective procedure to reduce the IOP in the treatment of different glaucomas with few severe complications. It is also suitable for primary surgical treatment.     

Contact trans-scleral diode laser cyclophotocoagulation treatment for refractory glaucomas in the Indian population

PURPOSE: This study aimed to evaluate the clinical efficacy of contact diode trans-scleral cyclophotocoagulation (TSCPC) for treatment of refractory glaucomas. METHOD: Fifty two eyes of 52 patients, (post-penetrating keratoplasty glaucoma: 16 eyes; adherent leucoma with secondary glaucoma: 8 eyes; aphakic glaucoma: 6 eyes; neovascular glaucoma: 6 eyes; narrow angle glaucoma: 6 eyes; and other secondary glaucomas: 10 eyes) were followed up from 3.5-18 months (average 12 months) after TSCPC. The treatment parameters using the contact G probe were--energy: 3-4J; area: 40 spots spread over 360 degrees; site: 1.2-1.5 mm posterior to limbus. Retreatments (22 eyes; 42%) were given whenever intraocular pressure (IOP) exceeded 22 mmHg despite maximum tolerable topical therapy. RESULTS: IOP decreased from a baseline of 44.7 (+/- 7.3) mmHg to 15 (+/- 3.7) mmHg at first week and was 15.2 +/- (8.2) mmHg at the last follow up. Successful control of IOP (< 22 mmHg) occurred in 30 (58%) eyes after a single treatment and in 48 (92%) eyes following retreatment. Complications included reduction in visual acuity from light perception (LP) only to no light perception (NLP) in two eyes and phthisis bulbi in one eye. CONCLUSION: Contact trans-scleral diode laser cyclophotocoagulation is effective in lowering IOP in eyes with intractable glaucoma with few side effects in Indian subjects.     

The immediate IOP response of Nd-YAG-laser iridotomy and its prophylactic treatability

The response of IOP in the normotensive human eye to Neodym-YAG-laser iridotomy was investigated in this study. In 2 series of 10 patients, each unilateral laser iridotomy was performed with a YAG-laser prior to cataract surgery. In one group laser iridotomy was done without pre-treatment, in the second group laser iridotomy was preceded by treatment with 1% pilocarpine. Close follow-up of IOP before and after surgery was carried out with the Non-Contact-Tonometer. Laser iridotomy caused average IOP rises of 10 mmHg, which could be identified as early as 20 min after surgery, with a maximum of response after 80 min, and a declining IOP from 100 min post-operatively onwards. Pre-treatment with pilocarpine eyedrops could be reduce the laser-mediated IOP rise to less than one fourth. These results recommend a mild miotic for routine pre-treatment for iris laser surgery in order to cope with acute pressure rise as one of the major problems in these procedures.     

Trans-scleral diode laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma

PURPOSE: To evaluate the success rate of contact diode transscleral cyclophotocoagulation (TSCPC) in pediatric refractory glaucoma. PATIENTS: and method: Twenty-eight eyes of 28 patients (age range 5 months to 26 years) with medical and surgical refractory pediatric glaucoma due to primary congenital glaucoma (group 1, 20 eyes) or aphakic congenital glaucoma (group 2: 8 eyes), were included in this retrospective study. All eyes underwent one or more TSCPC with the diode laser (Oculight SLX, Iris Medical) with a minimal follow-up of 2 months. Success was defined as intraocular pressure (IOP) between 6 and 20 mmHg after one or more procedures, with no increase in medical hypotensive therapy, and no progression to another hypotensive procedure. RESULTS: Mean baseline IOP was 29.4 +/- 7.8 mmHg (range 25 to 60 mmHg) and mean follow-up was 10.3 +/- 6.9 months (range 2 to 26 months). Success rates evaluated at 6 and 12 months (Kaplan Meier survival curves) were 54.4% and 27.7% respectively, with one-third of the eyes retreated once or more. These success rates were similar in both groups with a mean baseline IOP decrease of 38.9 +/- 15.9%. Postoperative uncontrolled hypertony occurred in the first 3 months in 6 (21.4%) eyes, leading to surgical IOP management. Other complications were decrease in visual acuity (14.3%), inflammation (25.5%) and phthisis (3.5%). CONCLUSION: TSCPC with the diode laser is a disappointing procedure for the management of refractory pediatric glaucoma, with poor mid-term IOP control and high incidence of complications including severe uncontrolled IOP increase. For these reasons, this cyclodestructive procedure should be considered as a last resort therapy for patients with refractory pediatric glaucoma.     

激光虹膜成形联合白内障超声乳化吸除术治疗急性闭角型青光眼

目的 分析激光虹膜成形术联合白内障超声乳化吸除术,对药物治疗不能迅速缓解的合并白内障的原发性闭角型青光眼急性发作的治疗效果.方法 对药物治疗不能迅速缓解的合并不同程度白内障的原发性闭角型青光眼急性发作患者12例(14只眼)行激光虹膜成形术以开放房角、控制眼压,而后行白内障超声乳化吸除联合人工晶状体植人术,随访(3～12)月,观察房角、眼压、视力变化及并发症情况.结果 激光虹膜成形术后超声生物显微镜检查示所有术眼房角开放;激光虹膜成形术前眼压(44.5±6.3)mmHg,术后2h、4h的眼压分别为(20.5 4±3.5)mmHg、(11.9 4±2.9)mmHg,与光凝前眼压的差异均有统计学意义(t=21.4956,P=0.000;t=241.5631,P=0.000);白内障超声乳化术后2周、3月的眼压均低于21mmHg,平均分别为(16.54±2.7)mmHg、(15.84±2.6)mmHg;激光虹膜成形术后和白内障超声乳化吸除术后视力不同程度提高;无严重并发症.结论 激光虹膜成形术能有效缓解药物治疗无效的原发性闭角型青光眼急性发作,并可作为白内障超声乳化吸除术治疗急性闭角型青光眼的前期治疗.     

Postoperative course of intraocular pressure after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE: To evaluate the natural course of intraocular pressure (IOP) after cataract surgery with combined primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the intraocular lens (IOL) in adult patients. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Fifty consecutive patients with age-related cataract awaiting cataract surgery under topical anesthesia in both eyes were enrolled prospectively. In randomized order, cataract surgery with combined PPCCC and POBH was performed in 1 eye. In the fellow eye, cataract surgery was performed conventionally with in-the-bag IOL implantation and the posterior lens capsule kept intact. Standardized IOP measurements by Goldmann applanation tonometry were performed 1, 2, 4, 6, 8, and 24 hours postoperatively. Follow-up IOP measurements were taken at 1 week and 1 month. Twenty-five patients received 1-time IOP-lowering medication immediately after cataract surgery; the other 25 did not receive IOP-lowering drops. RESULTS: During the first 24 hours postoperatively, no significant differences in IOP were observed between the PPCCC-POBH group and the conventional surgery group (P>.05). No IOP peaks greater than 27 mm Hg were observed in any eye. One week and 1 month postoperatively, no significant differences in IOP were found between groups (P>.05). The use of IOP-lowering drops significantly reduced postoperative IOP. However, no IOP spikes >27 mm Hg were found with and without the use of IOP-lowering drops. CONCLUSION: The course of IOP after cataract surgery with combined PPCCC and POBH showed the technique to be as safe as conventional cataract surgery with in-the-bag IOL implantation.     

Effect of diode laser trans-scleral cyclophotocoagulation in the management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments

AIMS: To evaluate the effect of trans scleral cyclophotocoagulation (TSCPC) on intraocular pressure (IOP) in the eyes retaining intravitreal silicone oil with medically uncontrolled secondary glaucoma following intravitreal silicone oil injection. METHODS: Medical records of 11 eyes of 11 patients who underwent TSCPC for medically uncontrolled glaucoma without pupillary block following intravitreal silicone oil injection for complicated retinal detachment were reviewed retrospectively. In all cases, intravitreal silicone oil was not removed for fear of retinal redetachment. Diode laser contact TSCPC was performed at a power of 1.5-2.5 W, for a duration of 2 seconds, and with 20-27 applications. IOP, number of glaucoma medications, and success rate were evaluated. RESULTS: After a mean follow up period of 52.5 (SD 8.2) (range 42-68) weeks, the mean pretreatment level of IOP, 43.0 (14.4) (26-67) mmHg, had fallen to 14.5 (4.3) (7-20) mm Hg (p=0.003). The number of glaucoma medications was reduced from 2.6 (0.8) to 0.6 (1.0) (p= 0.005). Qualified success was achieved in nine eyes (81.8%) and complete success in six (54.5%). After TSCPC, patients' retinal status had not changed. CONCLUSION: Patients with medically uncontrolled glaucoma secondary to intravitreal silicone oil injection can be treated with TSCPC in spite of the retained intravitreal silicone oil.     

Effectiveness of diode laser trans-scleral cyclophotocoagulation in patients following silicone oil-induced ocular hypertension in Chinese eyes

We evaluated the effectiveness of diode laser trans-scleral cyclophotocoagulation (TSCPC) on intraocular pressure (IOP) in nine patients having raised IOP following use of silicone oil (SO) for retinal detachment (RD) surgery in a retrospective observational case series. Diode laser TSCPC was applied at a power setting of 1.75 to 2.5 watts, for two sec with a maximum of 30 applications. The patients were followed up for 40 to 312 weeks. The mean pre-laser IOP was 32.06 mm Hg (SD 7.32). The mean post-laser IOP at one month, three months and six months was 17.89 mm Hg (SD 8.23), 21.89 mm Hg (SD 8.16) and 21.67 mm Hg (SD 7.55) respectively. The final IOP (at the last follow-up) was 19.56 mm Hg (SD 7.85) (P=0.021). Seven of them had undergone SO removal. In our observation, effectiveness of TSCPC in long-term control of SO-induced ocular hypertension was limited as compared to short-term control of IOP.     

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.     

Long-term follow-up of intraocular pressure after penetrating keratoplasty for keratoconus and Fuchs' dystrophy: comparison of mechanical and Excimer laser trephination

PURPOSE: In the literature, the incidence of "secondary glaucoma" after penetrating keratoplasty (PK) is reported to range from 10% to 42%, depending on the diagnosis and the complexity of surgery. The purpose of this study was to assess the impact of the trephination method and simultaneous cataract surgery on the early and long-term intraocular pressure (IOP) after PK in eyes without previous surgery and glaucoma. METHODS: Inclusion criteria for this prospective, randomized, longitudinal clinical study were (1) one surgeon (G.O.H.N.), (2) primary central PK, (3) Fuchs' dystrophy (7.5/7.6 mm) or keratoconus (8.0/8.1 mm), and (4) 16-bite double running diagonal suture. Exclusion criteria were (1) previous intraocular surgery, (2) preoperative glaucoma, and (3) postoperative trauma or endophthalmitis. In 170 patients (mean age, 51 +/- 18 years), PK was performed with use of either a 193-nm excimer laser (Excimer patients) along metal masks with eight orientation teeth/notches (50 keratoconus, 32 Fuchs') or motor trephination (Control patients; 53 keratoconus, 35 Fuchs'). In 27% of Excimer patients and 29% of Control patients a triple procedure was performed. The perioperative systemic acetazolamide application and the postoperative topical steroid therapy were standardized. RESULTS: Maximal IOP during the first week after PK was 15.7 +/- 3.6 mm Hg (7% > 21; maximum, 28) in the Excimer group and 16.2 +/- 3.5 mm Hg (7% > 21; maximum, 30) in the Control group. During a mean follow-up of 3.4 +/- 1.3 years (maximal, 6.0), an IOP >21 mm Hg and/or application of topical antiglaucomatous medication was documented in 9% of Excimer patients versus 15% of Control patients (p = 0.32), in 15% of Fuchs' dystrophy versus 11% of keratoconus cases (p = 0.41), and in 11% of PK-only versus 15% of triple-procedure cases (p = 0.68). The IOP elevation started an average of 3.7 +/- 2.8 months (1 week to 9 months) after PK and ended an average of 6.5 +/- 3.1 months (6 weeks to 12 months) after PK. Mean maximal IOP during follow-up was 16.6 +/- 3.5 mm Hg (12-38) in the Excimer group and 17.2 +/- 3.2 mm Hg (12-30) in the Control group. Only one patient, who had undergone a triple procedure for Fuchs' dystrophy and had an elevated IOP, needed topical medication, from 32 months after PK to the end of follow-up. Glaucomatous optic disc damage was clinically detected in none of the patients. CONCLUSIONS: Temporary secondary ocular hypertension after PK is rare in eyes with keratoconus or Fuchs' dystrophy without previous surgery. There was no detectable impact from the trephination method, the diagnosis, or simultaneous cataract surgery. With meticulous microsurgical technique, careful suturing, and peripheral iridotomy, the development of secondary glaucoma with disc cupping seems to be the exception.     

Intravitreal triamcinolone will cause posterior subcapsular cataract in most eyes with diabetic maculopathy within 2 years

PURPOSE: To determine the incidence of cataract following intravitreal triamcinolone (IVTA) for diabetic macular oedema. METHODS: Prospective, non-randomised, interventional cohort case series. A total of 27 eyes of 27 patients with diabetic macular oedema received an intravitreal injection of 4 mg (0.1 ml) of triamcinolone acetonide inferotemporally through the pars plana under direct vision. In 20 patients the fellow eye served as control, whereas seven patients had both eyes injected (not simultaneously). Seven patients had a repeat (second) injection in the same eye. The main outcome measures were cataract and intraocular pressure (IOP) rise of at least 5 mmHg (IOP responder). RESULTS: The mean follow-up time was 18.9 months (range 13-29 months). A total of 22 (81%) of 27 eyes developed cataract during the follow-up period, of which 20 (74%) were posterior subcapsular in nature. None of the 20 uninjected fellow eyes developed posterior subcapsular cataract. Mean time to cataract formation was 16.2 months. In the seven patients who had both eyes injected, mean time to cataract formation was 16.5 and 17.1 months in the first and second eye, respectively. Mean time to cataract formation in seven eyes receiving a repeat second injection was 17.9 months. There was no significant difference in cataract formation between IOP responders (85%) and non-responders (79%) (P=1.00, Fisher's exact test). Uneventful cataract surgery was performed in six eyes of five patients. CONCLUSION: This study demonstrates that given appropriate long-term follow-up, the majority of patients, even after a single IVTA injection, will go on to develop cataract, of which posterior subcapsular will be by far the most common.     

Treatment parameters for the efficacy of transscleral cyclophotocoagulation in rabbits using a diode laser

PURPOSE: To determine parameters for the efficacy of transscleral cyclophotocoagulation (TSCPC) using a diode laser. METHODS: We performed TSCPC on 74 pigmented rabbits with different exposure powers and varying number of applications, followed by clinical observation and histological examination up to 24 weeks. RESULTS: Based on observation of the clinical course, the most favorable parameters were 600 mW and 36 or 48 applications, which did not cause severe complications and sufficiently lowered intraocular pressure (IOP). Histological examination revealed coagulation of the epitheliums and stroma of the ciliary body at 600 mW. The stroma of the ciliary body was severely damaged at 900 mW. CONCLUSIONS: Transscleral cyclophotocoagulation at 600 mW with a larger number of applications than previously reported did not cause severe complications and effected greater and more lasting lowering of IOP than TSCPC with more intense coagulation and fewer applications.     

Primary and secondary herpes simplex uveitis in rabbits

Primary and secondary (recurrent) herpes simplex uveitis were studied in the rabbit eye. Intravitreal injection of liver herpes simplex virus (HSV) produced primary uveitis, and reinjection of HSV intravitreally in an eye that had completely recovered from the primary disease produced secondary uveitis. The onset of primary herpes simplex uveitis was gradual, but the secondary disease developed immediately after the intravitreal reinjection. Only live HSV would produce primary uveitis, whereas both inactivated and liver HSV could produce secondary uveitis. Infectious HSV could be isolated from the eye with primary uveitis, but not from the eye with secondary uveitis, a failure that appeared to be due in part to the persistence of anti-HSV neutralizing antibody in the eye after the primary uveitis. The results suggest that primary uveitis is caused by infection of the uveal tissue by live HSV, and that secondary uveitis is caused by HSV-induced immunological mechanisms.     

先天性无虹膜患者的临床分析

目的探讨先天性无虹膜患者的l临床表现及其治疗。方法为回顾性系列病例研究。选择1984年1月至2007年1月于我科就诊的8例（16只眼）先天性无虹膜患者,均为双眼患病,矫正视力均低于1．0。8例患者均伴不同程度白内障;其中5只眼伴青光眼,均为难治性青光眼;4只眼伴弱视;8只眼伴眼球水平震颤。根据病情不同分别行囊外白内障摘除术和人工晶状体植人术、小梁切除术、睫状突激光光凝术、戴镜行弱视训练、配戴角膜接触镜等治疗。结果6只晶状体明显混浊眼行白内障手术后视力有不同程度提高,无手术并发症。5只青光眼中,1只眼行小梁切除术,但术后眼压仍然不能控制于正常范围内,又行睫状突光凝术;3只眼仅行睫状突光凝术;1只眼局部使用降眼压药物治疗。此5只青光眼中,3只眼眼压得到控制,另2只眼仍不能控制于正常范围内。4只弱视眼经配镜、弱视训练后视力均有一定提高,2只眼配戴角膜接触镜后畏光症状得到缓解。结论先天性无虹膜患者眼部表现多种多样,虽治疗棘手,但经适当的治疗后可改善视力和临床症状。（中华眼科杂志．2008,44：46-49）     

白内障超声乳化IOL植入术后早期高眼压的临床分析

目的:探讨白内障超声乳化人工晶状体植入术后早期高眼压(IOP)发生的相关因素及应对措施.方法:对我院2014-01/2016-01完成的白内障超声乳化人工晶状体植入术658例726眼临床资料进行回顾分析.结果:术后发生高眼压共38眼,发生率为5.2％.术后眼压升高的幅度为21～ 55 mmHg,大多数患者出现高眼压的时间为术后6～24h.其中主要的相关因素:前房黏弹剂残留24眼(63.2％),葡萄膜炎9眼(23.7％),前房积血2眼(5.3％),皮质残留2眼(5.3％),囊袋阻滞综合征1眼(2.6％).应用降眼压药物,抗炎治疗联合前房放液,术后3d均能有效控制眼压≤21 mmHg,其中囊袋阻滞综合征1眼联合YAG激光治疗.结论:黏弹剂残留和炎症反应是引起术后高眼压的主要原因.术前评估,提高手术技巧,术后及时发现和正确处理,能有效防止术后高眼压,促进视功能的恢复.     

两种不同术式治疗新生血管性青光眼的临床观察

目的 回顾性分析半导体二极管激光经巩膜睫状体光凝术(TSCPC)和睫状体冷凝术治疗新生血管性青光眼(NVG)的临床资料,评价两种不同术式的疗效.方法 将50例(50只眼)NVG患者随机分为两组,TSCPC组26例(26只眼),睫状体冷凝组24例(24只眼).结果 对照组术后第1天眼压与本组术前相比差异无统计学意义(P＞0.05),第3天眼压明显下降,与本组术前相比差异具有统计学意义(P＜0.01).TSCPC组术后第1天眼压明显下降,与本组术前相比差异具有统计学意义(P＜0.01).术后两组同期眼压相比:第1 d、3 d、1周两组差异具有统计学意义(P＜0.01);1月、3月、6月两组差异无统计学意义(P＞0.05).TSCPC组术后早期疼痛时间短于对照组,差异有统计学意义(P＜0.01).两组术后视力及治疗有效率差异无统计学意义(P＞0.05).结论 两种手术方法 治疗NVG均有显著疗效.但相对于睫状体冷凝术TSCPC更安全、有效.

Abstract：

Objective To evaluate clinical effect of two different methods for the treatment of neovascular glaucoma (NVG) by analyzing data of diode laser transscleral cyclophotocoagulation (TSCPC) and cyclocryotherapy. Methods Fifty eyes of 50 patients with NVG were divided at random into two groups: 26 eyes treated by TSCPC (Test), 24 eyes by cyclocryotherapy (Control). Results There were no significant differences between postoperative IOP on lst day and preoperative IOP in control group (P ＞0.05), But there was a significant difference on 3rd day (P ＜0.01). There was a significant difference in TSCPC group on lst day (P ＜0.01). Compared to the postoperative IOP of two groups during the same period, there was a significant difference on ld, 3d, lw (P ＜0.01), and there were no significant differences at Im, 3m, 6m (P ＞0.05). The time of pain was shorter in TSCPC group (P ＜0.01). There was no significant difference between the two groups in postoperative visual acuity and the operating efficiency (P ＞0.05). Conclusions The two methods are effective for the treatment of NVG. However, TSCPC is an effective and safe method relatively.