不同点数半导体二极管激光经巩膜睫状体光凝对兔眼压影响的实验研究

目的研究不同点数半导体二极管激光睫状体光凝对兔眼压的影响及其病理变化。方法用波长为810nm半导体二极管激光对2组灰兔进行睫状体光凝,采用相同的能量不同的点数,并设一组对照,记录4周的眼压变化情况及不良反应,4周后取兔眼标本做睫状体的病理切片。结果光凝后2组灰兔的眼压均下降,随时间的增加,眼压有所回升,2组灰兔术前术后眼压变化值比较差异有统计学意义(P<0.01),光凝后睫状体的病理变化主要为睫状上皮的破坏和睫状体基质血管的充血及出血,并且激光的点数越多,对睫状体的破坏程度越严重。结论半导体二极管激光睫状体光凝的降眼压效果和激光击射的点数有关,不同点数的激光对睫状体有不同程度的破坏作用。     

不同能量二极管激光睫状体光凝的实验研究

目的：比较不同能量二极管激光睫状体光凝对家兔眼压的影响。方法：采用Ｖｉｓｕｌａｒｓ ＤｉｏｄｅⅡ二极管激光对两组有色素兔和一组无色素兔进行接触式经巩膜睫状体光凝术。激光击射部位在角巩膜缘后１～１．２ｍｍ,聚焦于睫状体,沿角巩膜缘共击射２４点,第一组有色素兔使用能产生爆破声的临界能量。第二组有色素兔用较低的能量,第三组无色素兔用相当高的能量。随访并记录２月的眼压及不良反应。结果：二极和激光睫状体光凝术可显著降低眼压,其中使用较高能量的有色素兔组具有最好的降眼压效果。结论：睫状体光凝的降眼压效果与激光能量、击射点数和术眼所含色素的多少有关。     

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.     

接触性二极管激光经巩膜睫状体光凝对角膜移植术后青光眼的治疗效果

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接触性二极管激光经巩膜睫状体光凝.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19～51mmHg)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%).其它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.     

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。     

改良二极管激光睫状体光凝术治疗中晚期青光眼

目的探讨经巩膜二极管激光睫状体光凝术(transscleral cyclophotocoagulation,TDLC)激光斑点数的选择治疗中晚期青光眼患者的疗效。方法连续收集2009年7月至2010年3月在我院接受TDLC治疗的不同类型中晚期青光眼患者27例27眼。根据青光眼患者术前眼压由低到高分为3组:在激光功率和持续时间(1500ms)不变的情况下,给予不同激光斑点数。随访术后1d、7d、14d、30d、60d、90d和180d的眼压,观察术后的近、中期效果。结果 27例27眼患者术前眼压为27～72(53.15±10.85)mmHg(1kPa=7.5mmHg),术后1d眼压为(28.78±7.40)mmHg,术后180d眼压为(18.37±2.02)mmHg。术后各阶段眼压平稳下降,并最终达到或接近正常眼压。术后任何同一时间点,90点组的术前术后眼压差都比70点组高,27例患者术后均未见视力下降发生。结论在激光功率和持续时间不变的情况下,按术前眼压给予不同的激光斑点数能更有效地控制术后眼压,不会增加并发症的发生和降低术后视力。     

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。     

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     

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。     

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。     

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。     

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.     

Semiconductor diode laser transscleral cyclophotocoagulation versus filtering surgery with Mitomycin-C

Both filtering surgery with Mitomycin-C and diode laser cyclophotocoagulation have proved to be effective alternatives in cases of glaucoma with poor surgical prognosis. The right eyes of 40 pigmented rabbits were randomly divided into 2 groups: Mitomycin-C group underwent filtering surgery with application of 0.4 mg/ml of Mitomycin-C whereas the diode laser (DL) group received 15 applications of 1.8 J (1800 mW. 1000 ms) distributed in 270°. Mean IOP showed statistical differences in two periods between days 3–13 and 45–60 — Mann-Whitney U test — with a higher IOP lowering in the DL group. The comparison of IOP survival curves (Log-Rank test) was not significant p = 0.070809. Ocular hypertension, hyphema and inflammatory signs were higher in the DL group, both in short and long term, but in terms of statistical significance only ocular hypertension showed differences p = 0.00011717 - Fisher exact test. Microscopic examination revealed patent sclerostomies in 60% of the MMC group eyes with different grades of fibroblastic proliferation. In the DL group we observed necrosis of the sclieral stroma and of the pigmented and unpigmented ciliary epithelium, with signs of thermal coagulation of the ciliary stroma and of the stromal vasculature. We must point out that the treatment with laser has proved to be more effective although both treatments showed very acceptable IOP lowering until 2 months after the surgery.     

Effect of diode laser contact transscleral pars plana photocoagulation on intraocular pressure in glaucoma

Purpose : To evaluate the efficacy of diode laser contact transscleral pars plana photocoagulation (CTPPP) for intraocular pressure (IOP) control in glaucoma and its clinical application. Method : A prospective, non‐randomized hospital‐based pilot study was conducted. Fourteen patients with poor visual acuity (VA worse than 6/60) and medically uncontrolled, refractory glaucoma were recruited, and CTPPP was performed after informed consent. Results : Mean preoperative IOP was 41.0 mmHg (SD 12.6, range 27?70, n = 14). At 1 week postoperatively, IOP was reduced in 12 of 14 (86%) patients to a mean of 28.6 mmHg (SD 15.8, range 3?55, n = 14). This represented a mean decrease of 12.4 mmHg. Mean IOP was 34.0 mmHg (SD 17.4, range 5?71, n = 14) and 31.6 mmHg (SD 13.4, range 5?22, n = 12) at 4 and 12 weeks, respectively. The IOP reduction was significant at 1 week (P = 0.001, paired t‐test) and at 12 weeks (P = 0.04, paired t‐test). The two patients with preoperative pain reported abolition of pain after the procedure. Seven of 13 patients on preoperative antiglaucoma eye drops did not require eye drops postoperatively. Conclusions : Diode laser CTPPP was found to significantly reduce IOP in the majority of patients at 1 week postoperatively, with less but still significant effect at 12 weeks. Its potential application as a procedure for short‐term IOP reduction in medically uncontrolled glaucoma requiring filtering surgery needs to be further investigated.     

Management of neovascular glaucoma with transscleral cyclophotocoagulation with diode laser alone versus combination transscleral cyclophotocoagulation with diode laser and intravitreal bevacizumab

Background: Trans‐scleral cyclophotocoagulation with diode laser has been well documented in the management of neovascular glaucoma. More recently, intravitreal bevacizumab has been increasingly employed to treat neovascular diseases of the eye. This study reports our initial experience with trans‐scleral cyclophotocoagulation alone versus the combination of trans‐scleral cyclophotocoagulation and intravitreal bevacizumab for management of neovascular glaucoma. Design: Retrospective uncontrolled comparative case series Participants: A total of 31 eyes of 30 consecutive patients were included – 11 eyes in the trans‐scleral cyclophotocoagulation alone group and 20 in the combination trans‐scleral cyclophotocoagulation and intravitreal bevacizumab group. Methods: The records of all patients diagnosed with neovascular glaucoma undergoing trans‐scleral cyclophotocoagulation with or without intravitreal bevacizumab performed by a single ophthalmic surgeon in a glaucoma specialist centre were reviewed. Main Outcome Measures: Data collected included intraocular pressure, anterior segment neovascularisation, best‐corrected visual acuity, use of medications and complications. Results: Mean reduction in intraocular pressure was 33.5 mmHg in the trans‐scleral cyclophotocoagulation group and 23.7 mmHg in the combination group, a difference of 9.8 mmHg (95% CI ?1.5, 21.1). Complications included hypotony in three (27%) eyes in the trans‐scleral cyclophotocoagulation group and two (10%) eyes in the combination group. Three eyes required evisceration. Conclusions: Trans‐scleral cyclophotocoagulation alone is effective in lowering intraocular pressure in neovascular glaucoma. In this study, the addition of intravitreal bevacizumab to trans‐scleral cyclophotocoagulation did not statistically advantage treatment outcomes.     

半导体激光经巩膜睫状体光凝治疗难治性青光眼

目的     

睫状体冷冻及经巩膜二极管激光光凝治疗重症青光眼的疗效分析

目的:比较睫状体冷冻及经巩膜二极管激光光凝治疗重症青光眼的效果。方法:收集我院2006-08/2007-10重症青光眼患者72例(72眼),用睫状体冷冻及半导体二极管激光治疗,随机分为两组,睫状体冷冻组36例(36眼),于角巩膜缘后2mm区域360°用液态二氧化碳冷冻机行睫状体冷冻,共6～8点,60～120s/点。睫状体光凝组36例(36眼),于角巩膜缘后1.5mm行全周睫状体光凝,激光点数16～36点,能量1.4～2.0W,脉冲时间0.5～2s。结果:对睫状体冷冻组及睫状体光凝组进行术后观察1,7d;1,3,6mo后分析比较,术后短期内:眼压降低、术后渗出反应及疼痛等指征有显著差异(P<0.05),远期各项比较无显著差异。结论:两组方法对于治疗重症青光眼,控制眼压,缓解疼痛均有显著疗效,睫状体光凝能量确切,操作简便安全,术后眼压下降迅速,对眼睑、结膜及巩膜等影响小,眼球萎缩及光感消失等发生几率低,而睫状体冷冻对于角膜变性、角巩膜葡萄肿及先天性大眼球等激光定位困难且易穿孔者有优势。     

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.