氩激光小梁成形术治疗原发性开角青光眼35例分析

以氩激光小梁成形术（ＡＬＴ）治疗原发性开角青光眼３５例５９只眼，其中２３例４２眼进行了随访，降压效果非常显著，ＩＯＰ＜２．８ｋＰａ（２１ｍｍＨｇ）３５眼，２．９３～３．２ｋＰａ（２２～２４ｍｍＨｇ）６眼，＞３．２ｋＰａ（２４ｍｍＨｇ）１眼。本法优点：术式可重复，方便，可在门诊治疗已成为药物不能控制与手术之间的过度措施。使用低能量１８０°范围５０个点，疗效良好，无术后高眼压等并发症。待病眼眼压控制后可逐渐减用抗青光眼药物；也可因疗效随时间衰退而辅以药物治疗，与手术相比，ＡＬＴ更为安全，尤运用于老年患者。     

Diode Laser Trabeculoplasty Versus Argon Laser Trabeculoplasty in the Control of Primary Open Angle Glaucoma

A randomised prospective study was carried out to determine whether diode laser trabeculoplasty (DLT) is as effective as argon laser trabeculoplasty (ALT) in the control of primary open angle glaucoma (POAG). Forty eyes of 40 patients with uncontrolled intraocular pressure (IOP) despite maximum topical medication were entered into the study. Twenty eyes received DLT, spot size 100 μm, exposure time 0.2 s, mean power 1034 (±56.4) mW. Twenty eyes received ALT, spot size 50 μm, exposure time 0.2 s, mean power 528 (±44.7) mW. They were reviewed at 2 h, 2 and 8 weeks, and 3, 6, 12, 18 and 24 months after laser treatment. Two eyes were withdrawn from the DLT group and four from the ALT group because of uncontrolled IOP during follow-up. Of the remaining eyes in the trial, mean IOP reductions for DLT and ALT, respectively, were: 6 months 7.42 (±2.36) mmHg and 6.36 (±2.3) mmHg; 12 months 7.02 (±2.6) mmHg and 6.28 (±2.2) mmHg; 18 months 6.86 (±2.8) mmHg, 5.98 (±2.02) mmHg; 24 months 6.50 (±2.72) mmHg, 5.92 (±2.02) mmHg. There was a significant reduction in each laser group when IOP at each stage was compared with baseline (p<0.001) (paired Student's t-test), but no significant difference between the two groups. In the ALT group peripheral anterior synechiae developed in four eyes and post laser pain in seven eyes. These complications were not noted following DLT. We conclude that DLT and ALT are equally effective in IOP control, but DLT is associated with less anterior segment inflammation. Paper received 18 February 1997; accepted after revision 14 August 1998.     

Descemet stripping with automated endothelial keratoplasty: A comparative study of outcome in patients with preexisting glaucoma

PurposeTo compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma.MethodsFor this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication (55) or with previous glaucoma surgeries (64) with a time-matched group of all other DSAEK cases (179, control).ResultsWith a mean follow-up of 1.85 ± 1.12 years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure (odds ratio OR = 12.35, 95% confidence interval CI [5.46–27.90], P < 0.001). Graft detachment was not associated with either history of glaucoma or glaucoma surgery (P > 0.05). Glaucoma on medication had no increased risks of graft failure compared to normal eyes (P = 0.38). However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries (OR = 4.26, 95% CI [1.87–9.71], P < 0.001). Medically managed glaucoma has increased risks of postoperative IOP elevation (OR = 2.39, 95% CI [1.25–4.57], P = 0.013), whereas surgically managed glaucoma has no significant elevation (P = 0.23). Elevation of IOP was not significantly correlated with graft failure (P = 0.21).ConclusionDSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival.     

倍频Nd：YAG激光小梁成形术疗效分析

为评价倍频Ｎｄ：ＹＡＧ激光小梁成形术的临床疗效。对２２例３８只临床用药物不能控制病情发展的原发性开角型青光眼，采用倍频Ｎｄ：ＹＡＧ激光实施小梁成形术，所有病例均治疗下半部１８０°小梁，５０个光凝点，局部组织产生苍白反应。结果：随访期内眼压平均下降０．７５ｋＰａ（５ｍｍＨｇ），眼压降幅与术前眼压水平成正相关。结论：倍频Ｎｄ：ＹＡＧ激光是行小梁成形术的有效激光，治疗参数为：光斑直径５０μｍ，功率０．７～１．２Ｗ，曝光时间０．１ｓ。     

真空小梁成形术治疗开角型青光眼及高眼压症

目的 观察真空小梁成形术对原发性开角型青光眼和高眼压患者的降眼压效果和安全性.方法 前瞻性病例系列研究.开角型青光眼及高眼压患者100例（100眼）作为研究对象.所有研究对象都接受了全面的眼科检查,包括眼压、计算机视野检查,并进行UBM或前房角镜检查,排除前房角关闭者.进行真空小梁成形术治疗仪治疗.治疗后1d、1周、1月、3月复查.首次治疗后7d重复治疗1次.观察治疗前后眼压变化.结果 100例术前眼压为（24.50±4.14） mmHg（1 mmHg=0.133 kPa）,治疗后1d、1周、1月、3月各时间点眼压为（22.96±3.66） mmHg,（21.27±2.91） mm-Hg,（19.65±2.77） mmHg,（19.80±1.79） mmHg,3个月观察期末与治疗前眼压差异均有统计学意义（P＜0.05）.3个月观察期内,无视力下降者.结论 本文短期研究显示,真空小梁成形术可安全有效地降低开角型青光眼及高眼压患者的眼压.     

Selective Laser Trabeculoplasty for Medically Uncontrolled Pseudoexfoliation Glaucoma in Korean Patients

PurposeThis study investigated the efficacy and safety of selective laser trabeculoplasty (SLT) in Korean patients with medically uncontrolled pseudoexfoliation glaucoma (PEXG).MethodsThis retrospective observational study enrolled 43 medically uncontrolled PEXG patients who underwent a 360° SLT and were followed up for at least 12 months after SLT. The intraocular pressure (IOP) before and after SLT at 1 week, 1, 3, 6, and 12 months was evaluated. Treatment success was defined as an IOP reduction of ≥20% from the baseline and an IOP equal to lower than 22 mmHg without additional anti-glaucomatous intervention. Additionally, every follow-up medical record was reviewed to assess any possible side effects of SLT.ResultsBased on the Kaplan-Meier survival analysis, the treatment success rate at 12 months after SLT was 41.9% (18 eyes). For the success group at the 12 months follow-up, SLT showed a mean IOP reduction of 10.3 ± 5.0 mmHg (from 25.6 ± 4.4 to 15.2 ± 2.9 mmHg; 39.3%, p < 0.05). Among the 25 eyes that were considered as the treatment failure group, 14 eyes underwent glaucoma filtering surgeries, four eyes received additional SLT, and further intervention and follow-up was refused for seven eyes. During the overall follow-up period, there were no significant adverse events.ConclusionsSLT is a partially effective and safe procedure for lowering IOP in Korean patients with medically refractory PEXG. Therefore, it can be considered as one of the alternative treatment modalities in patients who are at high risk for conventional filtering surgery.     

氩激光小梁成形术65例临床观察

目的评价氩激光小梁成形术对青光眼的疗效。方法应用进口氩激光机,对６５例不同类型开角型青光眼患者共７９只患眼进行光凝治疗。选用氩蓝激光,光凝部位选择在小梁网功能和非功能部位交界处。年迈体弱患者９例（１５眼）分二次光凝,每次光凝范围１８０°,光凝５０～６０点;余５６例（６４眼）一次性３６０°光凝９０～１２０点。结果治疗后随访３～３６个月,平均２４个月。眼压：６７眼（８４．８％）稳定在２０．５ｍｍＨｇ以下;１２眼（１５．２％）仍超过２５．８ｍｍＨｇ。视野：６６眼（８３．５％）无明显变化;７眼（８．９％）中心暗点扩大;６眼（７．６％）周边视野缩小。视力：８眼（１０．１％）提高;５眼（６３％）下降;余无明显变化。结论氩激光小梁成形术治疗开角型青光眼效果良好,原发性和继发性开角型青光眼均为激光治疗适应证。