基于爆破音的两种经巩膜睫状体光凝方案治疗难治性青光眼的疗效比较  

Efficacy comparison of two trans-scleral diode laser cyclophotocoagulation protocols based on“pop”for refractory glaucoma

作　　者：裴雪婷 王书华 Pei Xueting;Wang Shuhua(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2020年第2期147-151,共5页Ophthalmology in China

摘　　要：目的探讨根据爆破音调节经巩膜二极管激光睫状体光凝能量方案治疗难治性青光眼的疗效。设计回顾性比较性病例系列。研究对象难治性青光眼患者62例(62眼)。方法将患者随机分为爆破音调节能量组(调节组)30例(30眼),爆破音固定能量组(固定组)32例(32眼)。调节组在经巩膜二极管激光睫状体光凝术术中根据爆破音出现的频率不断调节能量。固定组以首次出现爆破音的能量完成手术。术后随访3个月。主要指标激光总平均能量、爆破音数量、眼压、视力、用药数量、术后并发症。结果术前及术后3个月调节组平均眼压分别为(46.1±10.7)mmHg和(15.8±6.9)mmHg;固定组分别为(44.9±12.3)mmHg和(16.7±8.2)mmHg。不使用降眼压药物眼压控制在21 mmHg以下者,调节组占80.0%,固定组占65.6%(χ^2=5.643,P=0.018)。爆破音数量与眼压下降幅度呈中度正相关(调节组r=0.517,P=0.001;固定组r=0.572,P=0.001)。调节组术后1例视力下降;固定组术后2例视力下降,1例持续性低眼压。结论爆破音调节能量的经巩膜睫状体光凝方案较爆破音固定能量方案对难治性青光眼的的疗效更好。Objective To evaluate the efficacy and safety of two trans-scleral diode laser cyclophotocoagulation(TDLCP)protocols based on“pop”for refractory glaucoma.Design Retrospective comparative case series.Participants Sixty-two eyes in 62 patients with refractory glaucoma.Methods Thirty patients(30 eyes)were treated with pop-titrated TDLCP,and 32 patients(32 eyes)were treated with fixed-energy TDLCP.The laser power was adjusted depending on the occurrence of an audible“pop”in pop-titrated group.The laser power was constant in fixed-energy group.The patients were followed up 3 months.Main Outcome Measures Total mean laser energy,pop numbers,intraocular pressure(IOP),visual acuity,anti-glaucoma medications,and complications.Results In pop-titrated group,mean IOP decreased from 46.1±10.7 mmHg before surgery to 15.8±6.9 mmHg 3 months after surgery.In fixed-energy group,mean IOP decreased from 44.9±12.3 mmHg before surgery to 16.7±8.2 mmHg on 3 months after surgery.80%patients in pop-titrated group whose IOP reduced to less than 21 mmHg without medications was significantly higher than 65.6%patients in fixed-energy group(χ^2=5.643,P=0.018).The IOP reduction was moderate correlated with the number of pops both pop-titrated group(r=0.517,P=0.001)and fixed-energy group(r=0.572,P=0.001).In pop-titrated group,BCVA decreased in 1 eye after TDLCP.In fixed-energy group,BCVA decreased in 2 eyes,and prolonged hypotonia occurred in 1 eye after TDLCP.Conclusion The pop-titrated TDLCP is more effective than the pop-fixed TDLCP for the treatment of refractory glaucoma.

关 键 词：经巩膜睫状体光凝术 难治性青光眼 

分 类 号：R779.6[医药卫生—眼科]