半导体激光透巩膜睫状体光凝治疗难治性青光眼

目的 :评价利用半导体激光透巩膜睫状体光凝治疗难治性青光眼的效果。方法 :对 34例难治性青光眼患眼进行 810nm半导体激光的透巩膜睫状体光凝 ,能量为 15 0 0～ 2 2 5 0mW ,时间为 2秒 ,范围 180°～ 2 70° ,观察 3～ 6个月的治疗效果。结果 :治疗前眼压为 5 1mmHg± 3 7mmHg ( 2 4～ 5 9mmHg) ,经过第一次治疗后的眼压是 18mmHg± 2 1mmHg ( 12～ 35mmHg)(P <0 0 1) ,最后统计的眼压是 17± 1 6mmHg ( 13～ 31mmHg) (P <0 0 1)。并发症主要是前房的炎症反应 ,在 2W左右消失。结论 :透巩膜半导体激光睫状体光凝是治疗难治性青光眼的一种有效的方法 ,而且操作方便 ,患者痛苦小。     

睫状体光凝术与玻璃体腔内注射治疗新生血管性青光眼的疗效比较

目的观察两种不同手术方案治疗新生血管性青光眼的疗效。方法将208例新生血管性青光眼患者随机分为研究组和对照组各104例。对照组给予患者睫状体光凝术治疗,研究组给予患者玻璃体腔内注射治疗。对比2组患者治疗后平均视力、平均眼压变化情况、并发症率及手术成功率。结果 2组患者治疗前眼压和视力差异无统计学意义(P>0.05)。治疗后3d、6个月眼压和视力水平均较治疗前有所恢复,且研究组优于对照组,差异有统计学意义(P<0.05)。研究组患者手术成功率显著高于对照组,并发症发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论玻璃体腔内注射能显著改善病情,提高手术成功率并降低并发症率,是一种安全高效的治疗方式。     

全视网膜光凝联合睫状体光凝治疗视网膜中央静脉阻塞引起的新生血管性青光眼

目的观察全视网膜光凝术联合经巩膜睫状体光凝术治疗视网膜中央静脉阻塞引起的新生血管性青光眼的临床效果。方法选取因视网膜中央静脉阻塞引起的新生血管性青光眼,分A组和B组。A组,白内障轻度,能行全视网膜光凝术;B组,白内障较重,不能行全视网膜光凝术。A组7例患者行全视网膜光凝联合睫状体光凝术。B组,7例患者仅行睫状体光凝术。结果 A组患者眼压下降,新生血管消失或部分消失,视力提高或保持视力;B组部分患者眼压下降,前房见积血或新生血管部分消退,部分患者眼压仍高,需二次睫状体光凝,视力光感或无视力。结论全视网膜光凝联合睫状体光凝能有效治疗视网膜中央静脉阻塞引起的新生血管性青光眼。     

半导体激光经巩膜睫状体光凝治疗无晶状体性青光眼

目的 评价半导体激光经巩膜睫状体光凝术治疗无晶状体性青光眼的效果及安全性.方法 30例(32眼)无晶状体性青光眼接受治疗,分析术后末次治疗后第三个月的眼压、视力和眼部症状.结果 术前眼压28-64mmHg,平均(34.56±14.63 mmHg),末次光凝术后第三个月眼压(26.47±6.52 mmHg),4眼需要二次手术,并发症:3眼(9.37%)有前房出血,12眼(37.50%)有前房闪辉反应,5服(15.63%)有角膜后沉着物.结论 经巩膜睫状体光凝有较其它治疗方式而言,是治疗无晶状体性青光眼的安全、有效的方法,但需要重复治疗.     

经巩膜睫状体光凝术治疗难治性青光眼的中期疗效观察--附33例报告

目的评价二极管激光经巩膜睫状体光凝术(transscleral cyclophotocoagulation,TSCPC)的中期有效性和安全性.方法对33眼难治性青光眼行TSCPC,术后随访观察患者的眼压、视力、症状及用药情况.结果平均随访34个月(24～46个月),术前、术后眼压分别为(6.9±1.8)kPa和(2.6±2.2)kPa,术后眼压比术前明显下降(P＜0.01);手术有效率为79%.4眼(12%)眼球萎缩;25眼(76%)视力不变,7眼(21%)视力下降,1眼(3%)视力提高;30眼(91%)疼痛明显缓解.术前用抗青光眼药种类平均为3.2(2～4)种,随访时减至平均0.2(0～2)种.结论TSCPC对于绝对期青光眼或不保留视功能的晚期青光眼是一种安全有效的治疗方法,但对于仍有视功能的患者,宜采用低能量击射的方法.     

A Retrospective Study of Transcleral Cyclophotocoagulation Using the Slow Coagulation Technique for the Treatment of Refractory Glaucoma

Purpose: To compare the success rates and safety of transscleral cyclophotocoagulation (TSCPC) for the treatment of refractory glaucoma using the slow coagulation technique and the conventional technique.

Methods: A retrospective, interventional case series of 44 patients (44 eyes) who underwent TSCPC using the slow coagulation technique (22 eyes) and conventional technique (22 eyes) in a tertiary hospital was done. The main outcome measures were success and complications. Success was defined as a final intraocular pressure (IOP) between 6 and 21 mmHg with or without IOP lowering medications with the cessation of oral carbonic anhydrase inhibitor at 12 months.

Results: Preoperative characteristics were statistically similar with regard to age, sex, laterality, diagnosis, IOP, and the number of glaucoma medications used. Both procedures had similar success rates of 40.9% and 36.3% in the conventional technique group and slow coagulation group, respectively (p = .757). The slow coagulation group had less prolonged anterior chamber inflammation (p = .048).

Conclusions: Diode laser TSCPC using the slow coagulation technique is a safe and effective technique for lowering IOP in patients with refractory glaucoma in Chinese eyes.     

玻璃体切除联合眼内镜下睫状体光凝治疗难治性青光眼

目的评价玻璃体切除联合眼内镜下睫状体光凝术治疗难治性青光眼的效果。方法对10例（10只眼）难治性青光眼均行玻璃体切除术和晶状体切除后在眼内镜下行激光睫状体光凝,激光能量0．6～0．87／,时间0．5s,光凝下方180°～220°范围,光凝30～40点。结果术后随访6～15个月,10例眼压均控制在〈21mmHg（1mmHg=0．133kPa）。最佳矫正视力提高者7例,不变者1例,不配合者1例,1例睫状体光凝术中出现脉络膜下爆发性出血。结论玻璃体切除联合眼内镜下睫状体光凝治疗难治性青光眼是一种相对有效的方法。     

Controlled Cyclophotocoagulation with diode laser in refractory glaucoma and long term follow up at King Abdulaziz University Hospital,Riyadh

Purpose

To evaluate the clinical efficacy and safety of controlled contact transscleral diode laser Cyclophotocoagulation (COCO) procedure in reducing the Intraocular Pressure (IOP) among patients with refractory glaucoma.

Methods

Thirty two patients (35 eyes) with refractory glaucoma in prospective clinical studies were treated with trans-sclera diode laser in a controlled manner. The energy power used was 5 W in adults and 3 W in children, exposure time was 0.5 s, a total of 16 shots were applied over ciliary body and four shots in each quadrant. Pre and postoperative IOP were measured at different postoperative visits. Snellen visual acuity, the number of anti-glaucoma medications and associated complications were also recorded. Student T test was used to compare the pre and post intervention IOPs, while Wilcoxon Signed Ranks test was used, to detect significance change in medication dependency.

Results

The mean (SD) follow up time was 80.2(±9.6) months, range (36–84) m, where the mean IOP was significantly reduced from 35.1 mm Hg (±10.7) before intervention to 18.8 mm Hg (±7.3) after intervention, in the final visit (P < 0.0001). Complete success was achieved in seven eyes (20%), 22 eyes (62.8%) showed qualified successes and complete failure was reported in six eyes (17.1%). The overall success rate was 82.8% (95% CI: 70.4–95.3). Visual acuity improved in three eyes (8.5%), no change took place in 27 eyes (77.1%) and decreased in five eyes (14.2%). The number of anti-glaucoma medications has significantly changed between pre and post intervention (P < 0.0001). No cases of hypotony, phthisis bulbi or sympathetic ophthalmia were reported.

Conclusion

Controlled COCO is a simple procedure, safe with minimal complications and fewer side effects.     

A study of the efficacy of endoscopic cyclophotocoagulation for the treatment of refractory glaucomas

Background

Endoscopic cyclophotocoagulation (ECP) is a relatively new method of cyclodestruction which can be used in the management of refractory glaucomas.

Aim

To evaluate the safety and efficacy of ECP in the management of refractory glaucomas.

Settings and Design

Prospective interventional non-comparative study.

Materials and Methods

Fifty eyes of 50 patients with refractory glaucoma, whose intraocular pressures (IOP) were not under control with maximal medical therapy underwent ECP, by the anterior, or pars plana route. IOP, best corrected visual acuity (BCVA), and the number of anti-glaucoma medications, were compared postoperatively to preoperative values. Success was defined as IOP ≤ 22 mmhg, with or without use of medications.

Statistical analysis used

Student''s t test and repeated measures ANOVA were used to evaluate change in IOP and Student''s t test, for comparison of BCVA. Kaplan Meier survival curve was plotted. Wilcoxon signed rank test was used to evaluate reduction in medications.

Results

Patients were followed for an average of 12.27 months (3-21months). IOP decreased significantly from 32.58 ± 9.16 mmHg to 13.96 ± 7.71 mmHg at last follow-up (P<0.001, student''s t test). BCVA was significantly improved in the postoperative period (P<0.001, student''s t test). The average number of antiglaucoma medications decreased from 2.51 ± 0.97 to 1.09 ± 1.16 (P<0.001, Wilcoxon signed rank test). ECP had a success rate of 82.2%.

Conclusion

Endoscopic cyclophotocoagulation is an effective procedure in this subset of refractory glaucomas.     

半导体激光经巩膜睫状体光凝治疗复杂性青光眼的护理

目的探讨半导体激光经巩膜睫状体光凝治疗复杂性青光眼的作用及有效的护理。方法对32例复杂性青光眼进行半导体激光睫状体光凝治疗,给予术前、术后的生理、心理及眼部护理,并制定相关的临床护理措施,使患者以最佳的状态完成手术。结果随访观察6~10个月,治疗前平均眼压为49.2±9.7 mmHg(33.8~63.7 mmHg),第1次治疗后为20.1±6.3 mmHg(12.1~36.2 mmHg),最后随诊为19.6±7.2 mmHg(10.6~33.4 mmHg),明显低于术前(P<0.01);24例眼压下降≥30%,手术成功率为75%,疼痛缓解率为90.6%。结论半导体激光经巩膜睫状体光凝是一种治疗复杂性青光眼的降低眼压疗效确切的方法,并发症少,可重复治疗,尤其适用于年龄较大、全身情况较差的病人及绝对期青光眼病人,配合相应的护理措施,可提高其生活质量。