经巩膜睫状体光凝术治疗原发性急性闭角型青光眼持续性高眼压的远期疗效  

Long-term efficacy of transscleral diode cyclophotocoagulation for primary acute angle-closure glaucoma with persistent ocular hypertension

作　　者：李维娜 杜亚茹 吴晓玉 Li Weina;Du Yaru;Wu Xiaoyu(Department of Ophthalmology,The 910th Hospital of the Joint Services Support Force,Quanzhou 362000,China)

机构地区：[1]联勤保障部队第910医院眼科,泉州362000

出　　处：《中华眼外伤职业眼病杂志》2022年第10期757-762,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：泉州市科技计划项目(2019N078S)。

摘　　要：目的探讨经巩膜二极管激光睫状体光凝术(TDCP)治疗原发性急性闭角型青光眼(PAACG)持续性高眼压的远期疗效。方法回顾性病例对照研究。选取2017年1月至2019年12月在联勤保障部队第910医院眼科确诊为PAACG急性大发作期102例(106眼), 根据治疗方式的不同, 将患者分为TDCP组50例(52眼)和小梁切除组52例(54眼)。所有患者接受全身和局部降眼压药物治疗后眼压持续升高。随访时间≥2年, 比较两组术前、术后最佳矫正视力(BCVA, logMAR)、眼压, 末次随访时使用降眼压药物的情况, 术后并发症及再次手术情况等。结果术前、术后1个月和末次随访时TDCP组的BCVA分别为2.44±1.05、1.72±1.23、1.76±1.26;小梁切除组分别为2.09±1.23、1.34±1.06、1.33±1.06。两组术后1个月和末次随访时BCVA均较术前提高(均P<0.001)。两组患者不同时间点BCVA的比较, 差异无统计学意义(均P>0.05)。术前、术后1个月和末次随访时TDCP组的眼压分别为(50.78±10.42)mmHg、(14.15±6.76)mmHg、(16.37±6.70)mmHg;小梁切除组分别为(48.14±10.09)mmHg、(15.02±5.65)mmHg、(18.06±6.84)mmHg (1 mmHg=0.133 kPa)。两组术后1个月和末次随访时眼压均较术前下降(均P<0.001)。两组患者不同时间点眼压的比较, 差异无统计学意义(均P>0.05)。末次随访TDCP组需用降眼压药物者占38.5%(20/52), 小梁切除术组为25.9%(14/54), 两组间差异无统计学意义(χ2=1.91, P=0.167)。随访期间TDCP组未出现持续性低眼压、眼球萎缩及巩膜变薄穿孔等严重并发症。再次行抗青光眼手术的比例, TDCP组(28.8%, 15/52)明显高于小梁切除组(5.6%, 3/54)(χ2=10.19, P=0.001)。结论 TDCP治疗PAACG持续性高眼压远期随访安全性高, 可以作为PAACG的紧急处理方法之一。Objective To investigate the long-term efficacy of transscleral diode cyclophotocoagulation(TDCP)in the treatment of primary acute angle-closure glaucoma(PAACG)with persistent ocular hypertension.Methods This was a retrospective case-control study.The clinical data of 106 eyes of 102 patients with acute PAACG from Jan.2017 to Dec.2019 in the 910th Hospital of the Joint Services Support Force were collected.These patients were divided into two groups,52 eyes of 50 cases in the TDCP group and 54 eyes of 52 cases in the trabeculectomy group based on the treatment method.All cases received systemic and local anti-glaucoma drugs,and the IOP continued to rise.The follow-up time was≥2 years.The best corrected visual acuity(BCVA,logMAR)and IOP before and after operation between the two groups were compared.The kinds of anti-glaucoma drugs,postoperative complications and reoperation during the follow-up were compared between the two groups as well.Results BCVA(logMAR)in the TDCP group before,at 1 month after surgery and the last follow-up was 2.44±1.05,1.72±1.23,1.76±1.26,respectively.BCVA in the trabeculectomy group was 2.09±1.23,1.34±1.06,1.33±1.06,respectively.The BCVA of the two groups improved at 1 month and last follow-up time(all P<0.001).The difference of BCVA was not statistically significant before,at 1 month after surgery and the last follow-up between the two groups(all P>0.05).IOP in the TDCP group before,at 1 month after operation and last follow-up was(50.78±10.42)mmHg,(14.15±6.76)mmHg,(16.37±6.70)mmHg respectively,that in the trabeculectomy group was(48.14±10.09)mmHg,(15.02±5.65)mmHg,(18.06±6.84)mmHg respectively.IOP of the two groups were improved after operation(all P<0.001).There were no statistical difference in IOP before and after operation between the two groups(Fgroup=0.01,P=0.977).At the end of the follow-up time,38.5%(20/52)of the patients in the TDCP group and 25.9%(14/54)in the trabeculectomy group needed IOP lowering drugs,with no significant difference(P>0.05).There were no seri

关 键 词：经巩膜二极管睫状体光凝术 小梁切除术 闭角型青光眼 远期 疗效 

分 类 号：R779.6[医药卫生—眼科]