二氧化碳激光辅助下深层巩膜切除术治疗开角型青光眼效果观察  

Effect observation of CO_(2) laser-assisted sclerectomy surgery in the treatment of open-angle glaucoma

作　　者：彭显耀 李武靓 邬一楠 袁建树 徐晓萍 PENG Xianyao;LI Wuliang;WU Yinan(Department of Glaucoma,The Ningbo Eye Hospital,Ningbo 315000,China.)

机构地区：[1]宁波市眼科医院青光眼科,浙江宁波315000

出　　处：《全科医学临床与教育》2021年第9期777-780,F0002,共5页Clinical Education of General Practice

基　　金：宁波市鄞州区农业与社会发展科技计划(鄞科[2017]110号)。

摘　　要：目的评估二氧化碳激光辅助下深层巩膜切除术(CLASS)应用于药物治疗无效的开角型青光眼(OAG)的安全性及有效性。方法选取确诊为OAG并且经药物治疗无效的患者17例为研究对象,所有患者均接受CLASS治疗。在术前2周内完成包括眼压在内的基线检查,记录术中和术后并发症,记录术后1 d、1周、1个月、3个月、6个月、12个月眼压,并进行术后眼压评价。结果 17例(22只眼)受试者中,均未记录到CLASS术中设备故障。有1例(1只眼)患者发生术中设备相关性巩膜池穿孔,有2例仅随访了1个月。14例OAG患者共19只眼完成CLASS,并随访12个月。8例(10只眼)术后出现了虹膜前粘连(PSA)。14例OAG患者基线眼压为(32.82±2.14)mmHg,术后1天眼压为(9.17±4.68)mmHg,术后1周眼压为(13.81±6.32)mmHg,术后3个月眼压为(18.61±5.28)mmHg,术后6个月眼压为(18.32±0.97)mmHg,术后12个月眼压为(16.37±1.01)mmHg。术后6个月和12个月眼压分别较基线眼压下降(14.50±2.47)mmHg(95%CI 7.97~21.03,P<0.05)和(16.45±2.21)mmHg(95%CI 10.63~22.27,P<0.05)。CLASS术后6个月和12个月的完全成功率分别为57.90%和36.80%,而限制性成功率为84.20%和73.70%。结论CLASS为一种安全有效且易于操作的OAG术式。Objective To evaluate the safety and efficacy of CO2 laser-assisted sclerectomy surgery(CLASS)in the treatment of open-angle glaucoma(OAG)with ineffective drug therapy.Methods Seventeen patients who were diag-nosed with OAG and ineffective to drug treatment were enrolled in the study,and all patients received the treatment of CLASS.Baseline examinations was completed within 2 weeks before CLASS,recorded intraoperative and postoperative complications,and intraocular pressure(IOP)at baseline,1 day,1 week,1 month,3 months,6 months,and 12 months postoperation were recorded and evaluated.Results Among the seventeen patients(22 eyes),none of intraoperative equipment failures were recorded.One patient(one eye)had intraoperative device-related scleral perforation,and two patients followed-up for 1 month postoperation.Finally,fourteen patients(19 eyes)finished CLASS and completed the 12-month follow-up.Eight patients(10 eyes)occurred PAS postoperation.The mean baseline IOP of 32.82±2.14 mmHg dropped to 9.17±4.68 mmHg,13.81±6.32 mmHg,18.61±5.28 mmHg,18.32±0.97 mmHg,16.37±1.01 mmHg at 1 day,1 week,3 months,6 months and 12 months postoperation.The postoperative IOP at 6 months and 12 months were decreased 14.50±2.47 mmHg(95%CI 7.97-21.03,P<0.05)and 16.45±2.21 mmHg(95%CI 10.63-22.27,P<0.05)compared with baseline.Complete success rate were achieved by 57.90%and 36.80%of the patients at 6 months and 12 months,whereas qualified success rate were achieved by 84.20%and 73.70%of the patients at 6 months and 12 months,respectively.Conclusion CLASS is a simple,safe,and effective method for the treatment of OAG.

关 键 词：开角型青光眼 非穿透性 深层巩膜切除术 

分 类 号：R779.6[医药卫生—眼科]