小剂量激光睫状体成形术治疗急性闭角型青光眼的试点研究

目的 观察小剂量激光睫状体成形术（low dose trans-scleral cycloplasty，LDCP）治疗急性闭角型青光眼后前房深度和房角参数的变化。设计 前瞻性病例系列。研究对象 2018年5月至 2019年11月温州医科大学附属眼视光医院急性闭角型青光眼急性大发作患者12例15眼，年龄（54.7±14.1）岁。方法 LDCP是采用较少激光点数（能量1200~2000 mw，持续时间2 s）、仅对2个钟点范围睫状体光凝而达到睫状体重塑、松解睫状环阻滞的一种方法。分析治疗前和治疗后1周、1个月、3个月的临床资料。主要指标 眼压、中央前房深度、房角开放距离500 （angle opening distance 500，AOD500）、小梁网-虹膜夹角500 （trabecular iris angle 500，TIA500）、最大睫状突厚度（CBTmax）、小梁睫状突夹角（TCA）、降眼压药物使用情况。结果 15眼平均激光治疗点数为（13.3±2.3）（9~16个点）。治疗前眼压中位数（范围）为26.6（7.3~60.0） mmHg，治疗后1周为10.6（6.1~53.9） mmHg（Z=-2.726，P=0.006）。治疗前抗青光眼药数量中位数（范围）为3 （0~5）种，治疗后1周为0 （0~3）种 （Z=-3.078，P=0.002）。超声生物显微镜（ultrasound biomicroscopy，UBM）显示平均中央前房深度、AOD500和TIA500分别由治疗前的（1.44±0.48）mm、0.00（0~0.19） mm、0.00（0~20.1）°，增加至治疗后1周的（1.66±0.34）mm、0.04（0~0.28）mm、4.63（0~28. 5）°  （P均<0.05）；平均CBTmax和TCA分别由治疗前的（0.98±0.12）mm和（55.7±16.8）°，增加至治疗后1周的（1.05±0.09）mm和 （66.8±17.3）° （P=0.060，0.004）；13眼（86.7%）周边前房深度（Van Herick法）较治疗前有不同程度的增加。8眼在治疗后1个月内因不同原因行白内障手术，未行二次手术治疗的7眼治疗后3个月的中位数眼压和平均前房深度分别为15.5 mmHg和1.73 mm。结论 LDCP可明显加深急性闭角型青光眼的中央和周边前房，具有良好的即时降眼压效应，为闭角型青光眼急性期的治疗提供了一种新思路，但该治疗的安全性有待进一步观察。（眼科，2021，30： 30-35）

Preliminary reports of low dose trans-scleral cycloplasty in acute angle closure glaucoma

Objective To evaluate the short-term changes of anterior chamber depth and angle parameters in acute angle closure glaucoma underwent low dose trans-scleral cycloplasty(LDCP).Design Prospective case series.Participants 15 eyes from 12 patients were diagnosis as cute angle closure glaucoma patients with sudden attack at the Eye Hospital of Wenzhou Medical University from May 2018 to November 2019.Methods LDCP is a treatment adopting few laser points(1200~2000 mW energy,2 seconds duration)that burns the ciliary body over two hour-positions to shrink ciliary body and release ciliary block.Acute angle closure glaucoma patients underwent low dose trans-scleral cycloplasty(LDCP).The mean age was(54.7±14.1)years old(22~72 years old),including 5 males and 7 females.Data before LDCP and one week,one month,three months after LDCP were collected.Main Outcome Measures Intraocular pressure,central anterior chamber depth,angle opening distance 500(AOD500),trabecular-iris angle 500(TIA500),maximum ciliary body thickness(CBTmax),trabecular-ciliary angle(TCA)and number of medications.Results The mean number of laser burns was(13.3±2.3)(9~16).The median preoperative IOP(range)was 26.6(7.3~60.0)mmHg with the median medication number of 3(0~5).The median postoperative IOP was 10.6(6.1~53.9)mmHg(Z=-2.726,P=0.006)with the median medication number of 0(0~3)(Z=-3.078,P=0.002).The central anterior chamber depth measured by ultrasound biomicroscopy(UBM)was increased from(1.44±0.48)mm preoperatively to(1.66±0.34)mm postoperatively,respectively(t=-2.783,P=0.015).And the AOD500 and TIA500 values measured by UBM had a significant difference between preoperative and postoperative(all P<0.05).The CBTmax and TCA values measured increased from preoperation topostoperation(CBTmax:P=0.060;TCA:P=0.004).The deepen of peripheral anterior chamber was observed by van Herick technique respectively in thirteen eyes(86.7%).8 eyes underwent cataract surgery for different reasons within one month after LDCP.Among 7 eyes without secondary surgery,the median IOP was 15.5 mmHg and mean anterior chamber depth was 1.73 mm three months after LDCP.Conclusion Preliminary study shows that LDCP can significantly deepen the central and peripheral anterior chamber of acute angle closure glaucoma and reduce the intraocular pressure quickly,which provides a new idea for the treatment of angle closure glaucoma in acute phase.However,the safety of this treatment needs to be further observed.(Ophthalmol CHN,2021,30:30-35)