选择性激光小梁成形术治疗激素性青光眼的疗效分析  

Effect of Selective Laser Trabeculoplasty in the Treatment of Steroid-Induced Glaucoma

作　　者：游蕊荣 戴玛莉 解彦茜 王毓琴 张绍丹 梁远波 吕帆 Ruirong You;Mali Dai;Yanqian Xie;Yuqin Wang;Shaodan Zhang;Yuanbo Liang;Fan Lu(Eye Hospital,Wenzhou Medical University,National Clinical Research Center for Ocular Diseases,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属眼视光医院,国家眼耳鼻喉疾病临床医学研究中心(眼部疾病),温州325027

出　　处：《中华眼视光学与视觉科学杂志》2024年第2期120-126,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家重点研发计划项目(2020YFC2008200);温州医科大学附属眼视光医院创新引导重点项目(YNZD2201903)

摘　　要：目的:评价选择性激光小梁成形术(SLT)治疗激素性青光眼(SIG)的有效性和安全性。方法:回顾性系列病例研究。连续纳入2017年1月1日至2022年12月31日在温州医科大学附属眼视光医院接受SLT治疗的SIG患者17例(25眼)。收集患者SLT术前,术后1周、2周和1、3、6个月以及末次随访时的病例资料,主要观察指标包括眼压、使用抗青光眼药物种类、治疗成功率、激光相关并发症。治疗成功定义为不需要增加抗青光眼药物种类及抗青光眼手术情况下,术后眼压≤21 mmHg(1 mmHg=0.133 kPa)且较基线下降百分比超过20%。采用单因素重复测量方差分析比较SLT手术前后眼压,采用秩和检验比较SLT手术前后抗青光眼药物种类。采用Kaplan-Meier生存分析评估治疗累积成功率。结果:纳入患者术前基线眼压为(34.6±8.1)mmHg,使用抗青光眼药物3(3,4)种。随访时间(16.8±11.3)个月。术后1周、2周和1、3、6个月及末次随访眼压分别为(25.6±8.2)(20.2±8.1)(18.0±7.7)(14.7±3.6)(16.2±4.4)(15.7±3.9)mmHg,与术前相比均明显下降(均P<0.001)。术后3个月和6个月抗青光眼药物种类与术前相比分别降至0(0,2)种和0(0,0.5)种,差异均有统计学意义(均P<0.001)。术后3个月、6个月和末次随访的累积治疗成功率分别为80.0%、72.0%和61.7%。所有患者均未出现明显的术中和术后并发症。结论:SLT可有效降低和维持SIG患者的眼压且安全性良好,有望成为临床治疗SIG的首选方式。Objective:To evaluate the efficacy and safety of selective laser trabeculoplasty(SLT)in the treatment of steroid-induced glaucoma(SIG).Methods:In retrospective case series,17 cases(25 eyes)of SIG who underwent SLT at the Eye Hospital,Wenzhou Medical University from January 1,2017 to December 31,2022 were included.Medical records of patients were reviewed pre-and post-SLT at week 1,2,month 1,3,6 and the last follow-up.Main outcome measures included intraocular pressure(IOP),the number of anti-glaucoma drugs,treatment success rate,and laser-related complications.Successful treatment was defined as post-SLT IOP≤21 mmHg(1 mmHg=0.133 kPa)and reduction in IOP of more than 20%from baseline without the need for an increase in the number of anti-glaucoma drugs and surgery.Pre-and post-SLT IOP was compared with repeated measured ANOVA.The number of anti-glaucoma drugs pre-and post-SLT was analyzed with rank sum test.Kaplan-Meier survival analysis was used to evaluate the cumulative success rate.Results:Baseline IOP was 34.6±8.1 mmHg and the number of anti-glaucoma drugs was 3(3,4).The follow-up period was 16.8±11.3 months.Post-SLT IOP at week 1,2,month 1,3,6 and the last follow-up were 25.6±8.2,20.2±8.1,18.0±7.7,14.7±3.6,16.2±4.4,and 15.7±3.9 mmHg,respectively,showing significant reductions compared to baseline(all P<0.001).The number of anti-glaucoma drugs at 3,6 months post-SLT decreased to 0(0,2)and 0(0,0.5),respectively(both P<0.001).Cumulative treatment success rates at month 3,6 and last follow-up were 80.0%,72.0%,and 61.7%,respectively.No significant intraoperative or postoperative complications were observed.Conclusion:SLT can effectively reduce and maintain the IOP of SIG with good safety,it may become the first choice for SIG treatment.

关 键 词：青光眼 选择性激光小梁成形术 激素性青光眼 眼压 

分 类 号：R779.6[医药卫生—眼科]