半导体激光经巩膜睫状体光凝治疗青光眼

目的评估半导体激光经巩膜睫状体光凝治疗青光眼的疗效及安全性。方法对１０２例患者的１０５只药物无法控制眼压且又不宜行滤过手术的重症青光眼（眼压３４～８２ｍｍＨｇ，平均４４ｍｍＨｇ±１１ｍｍＨｇ），通过Ｇ探头行半导体激光经巩膜睫状体光凝治疗，激光功率１５～２０Ｗ，脉冲时间２ｓ，避开颞侧９０°，在剩余的２７０°范围内击射１２～２０点，点间距２ｍｍ。以激光治疗后眼压≤２１ｍｍＨｇ且除外眼球萎缩为治疗成功。结果治疗后经过６～１８个月（平均１２．５个月）的随访观察，治疗成功率达７２．４％（７６／１０５），疼痛控制率为９５．２％（５９／６２）。治疗后平均眼压为２０ｍｍＨｇ±８ｍｍＨｇ，较治疗前下降５５％（Ｐ＜０．００１）。每天使用降眼压药物次数由治疗前的２７±０９减至１３±１１，减少５２％（Ｐ＜０．０５）。晚期并发症有慢性色素膜炎（５眼，４．８％）、眼球萎缩（４眼，３．８％）、光感丧失（４眼，３．８％）和低眼压（３眼，２．９％）。结论半导体激光经巩膜睫状体光凝是治疗难治性青光眼相对安全、简便、副作用小的有效方法。

Contact Transscleral Cyclophotocoagulation with Diode Laser in the Treatment of Uncontrolled Glaucoma

Objective To evaluate the effect and safety of transscleral cyclophotocoagulation with diode laser for glaucoma treatment. Methods One hundred and five eyes of 102 patients with severe glaucoma(mean IOP was 44 mmHg11 mmHg) which were neither controlled by medicine nor suitabe for filtering surgery were treated with diode laser transscleral cyclophotocoagulation using Gprobe. Each laser application was spaced out 2 mm apart, which produce burns in the ciliary processes during 2 second duration. Omitting to treat the temporal 90 of the circumference of the ciliary body, we delivered 1220 shots in the remaining 270 with a power of 1.52.0 W. Results Followup observations were conducted for all patients for 6 to 18 months (mean 12.5 months) after diode laser treatment. Overall success rate was 72.4%(76/105). Of the painful eyes, 95.2%(59/62) were rendered comfortable. Mean postoperative IOP was 20 mmHg8 mmHg and compared with the IOP before treatment a 55% reduction was revealed ( P <001). The times of antiglaucoma medications used before treatment were decreased from 2.7 0.9 to 1.31.1, which reduced 52%( P <005). The incidence of complications was low. Chronic uveitis occurred in 4.8%, atrophy of eyeball in 3.8%, hypotony in 2.9%, loss of light perception in 3.8%. Conclusions Diode laser transscleral cyclophotocoagulation has such advantages as simplicity, convenience, safety and reliability, so it is one of the effective therapeutic methods to cure refractory glaucoma.