选择性激光小梁成形术治疗硅油填充眼继发性青光眼

目的：评估选择性激光小梁成形术(SLT)在硅油乳化相关继发性开角型青光眼(SO-OAG)中的降眼压作用。

方法：采用回顾性分析,选择硅油乳化取出后未达安全眼压的SO-OAG患者120例120眼,应用360° SLT治疗。评估患者治疗1wk, 1、3mo后平均眼压、用药种类和成功率。

结果：SLT治疗1wk, 1、3mo时的平均眼压分别为17.64±4.52、18.96±3.33、18.03±5.69mmHg,较治疗前眼压(25.02±5.93mmHg)明显降低(P=0.002、0.04、0.03); 治疗1wk, 1、3mo后的平均用药种类分别为1.78±0.14、1.95±0.56、1.87±0.53种,较治疗前(3.11±0.62种)明显降低(P=0.006、0.04、0.02); 治疗1wk后,显效82眼(68.3%),有效24眼(20.0%); 治疗1mo后,显效74眼(61.7%),有效21眼(17.5%); 治疗3mo后,显效77眼(64.2%),有效15眼(12.5%)。

结论：SLT能有效降低最大耐受药物治疗不能控制眼压的SO-OAG患者的眼压。     

Clinical results of selective laser trabeculoplasty

PURPOSE: Selective laser trabeculoplasty (SLT) is a new technique aimed to developed to impact pigmented trabecular cells selectively. Compared with ordinary argon laser trabeculoplasty, it is expected to have fewer complications with more efficacy for open-angle glaucoma. In this study we performed SLT on 17 eyes of 10 patients with primary open-angle glaucoma and 1 eye with capsular glaucoma. METHODS: Follow-up period was up to 10 months. Average energy irrachieted was 28.14 mJ (0.47 mJ x 59 spots) against pigmented trabecular band over the half circumference of anterior chamber angle. RESULTS: Preoperative mean intraocular pressure (IOP) was 22.8 mmHg and postoperative mean IOP was decreased significantly to 8.6, 17.3, and 16.1 mmHg at 1, 3, and 6 months after treatment, respectively. The average maximum IOP reduction was 8.8 (3-18) mmHg after SLT. Among 11 eyes showing transient IOP elevation, 6 eyes had an elevation of more than 5 mmHg. No remarkable postoperative complications were noted. CONCLUSION: SLT is a safe and effective modality for the treatment of open-angle glaucoma such as primary open-angle glaucoma (POAG) and capsular glaucoma.     

Clinical results of selective laser trabeculoplasty]

PURPOSE: Selective laser trabeculoplasty (SLT) is a new laser procedure using a frequency-doubled Q-switched Nd: YAG laser (wavelength: 532 mm). The laser parameters are set to selectively target pigmented trabecular meshwork (TM) cells without coagulative damage to the TM structure or non-pigmented cells. We investigated the safety and efficacy of SLT in lowering intraocular pressure (IOP). SUBJECTS AND METHOD: Sixty-seven eyes of 67 patients with uncontrolled open angle glaucoma were treated with the Coherent Selecta 7000 (Coherent Inc., Palo Alto, CA). Nineteen of 67 patients had previously received argon laser trabeculoplasty (ALT). A total of approximately 60 non-overlapping spots were placed over 180 degrees of the TM ranging from 0.5 to 1.0 mJ per pulse. The maximum energy level at which no bubble formation was observed determined choice. RESULTS: The average preoperative IOP was 22.4 mmHg. Six months after the operation, mean IOP reduction was 4.4 mmHg, and mean outflow pressure (OP) reduction was 38.1%. One month after the operation 68.7% of patients responded to treatment with an OP reduction of at least 20% ("responders"). Transient IOP elevation of 5 mmHg or greater was seen in 25.4% of patients. The success rate at 6 months after operation was 64.6% for all patients (67 eyes) and 78.2% for the responders (46 eyes). An analysis using a Cox proportional hazard model showed that a low preoperative IOP was the significant determinant for success, and the hazard ratio for the IOP increase of 5 mmHg was 2.12. Other factors such as age, gender, past history of ALT, and goniopigment were not significantly related to success. CONCLUSION: SLT appears to be a safe and effective way to lower IOP.     

硅油眼继发青光眼植入AGV的治疗分析

目的:分析硅油眼继发青光眼植入Ahmed青光眼阀门(Ahmedglaucoma valve,AGV)的治疗效果。方法:对11例硅油眼引起继发性青光眼进行AGV植入,术后随访1a以上。结果:术前平均眼压45.35±13.96mmHg。术后1,2,3,4wk;3,6,12mo时眼压分别为16.11±4.82,15.98±4.78,15.91±4.78,16.51±4.94,16.66±5.01,16.37±4.90,16.79±5.06mmHg。术后各个时期眼压与术前相比均有显著性差异(P<0.05)。结论:AGV植入于硅油眼继发性青光眼是一种可行的有效治疗方法。     

Clinical results of selective laser trabeculoplasty as adjunctive treatment for primary open-angle glaucoma patients

PURPOSE: We retrospectively investigated the intraocular pressure (IOP) lowering effects of selective laser trabeculoplasty (SLT) as adjunctive treatment for glaucoma patients receiving maximal medical therapy. METHODS: Thirty-four eyes of 34 patients with primary open-angle glaucoma who had no prior surgical therapy and has received SLT for the first time were included in this study. The results of their laser treatment were analyzed retrospectively. The age of patients was 61.1 +/- 13.0 (mean +/- standard deviation) years, the follow-up period was 7.1 +/- 4.8 months, and the number of medications before SLT was 3.5 +/- 0.7. A total of 57.0 +/- 11.5 spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.5 to 1.4 mJ per pulse. RESULTS: The IOP significantly decreased from 20.9 +/- 3.4 mmHg at baseline to 18.7 +/- 4.6 mmHg at 1 month after SLT (p < 0.01). Kaplan-Meier survival analysis showed that success rates at 6 and 12 months after SLT were 48.6% and 23.2%, respectively. CONCLUSIONS: Although SLT significantly decreas ed the IOPs in Japanese patients with primary open-angle glaucoma receiving maximal medical therapy, the effects may be for a limited time only, as adjunctive treatment.     

Evaluating selective laser trabeculoplasty versus argon laser trabeculoplasty in pseudoexfoliation glaucoma patients

Objective

Laser trabeculoplasty effectively reduces intraocular pressure (IOP) in primary open angle glaucoma, with argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) showing equivalent outcomes. However, it is unclear which laser modality is more effective in pseudoexfoliation (PXE) glaucoma. This study aims to compare the effectiveness of ALT and SLT in PXE glaucoma.

选择性激光小梁成形术治疗残余原发性闭角型青光眼的临床评价

背景 选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)的安全性和有效性已得到人们广泛的认同,但迄今为止SLT治疗闭角型青光眼的研究较少,其效果和安全性尚待临床观察证实.目的 评价SLT治疗残余原发性闭角型青光眼(PACG)的疗效及安全性.方法 采用病例观察性研究设计.共纳入经激光周边虹膜成形术和/或激光虹膜周边切除术治疗后前房角开放但眼压不能降至正常的闭角型青光眼患者23例33眼,术前平均眼压(24.78±4.48)mmHg,日平均用药指数(1.62±0.66)分.所有眼的前房角能看到小梁网的范围约180°.用Q开关倍频Nd:YAG激光机在患眼开放的前房角照射小梁网,在180°范围内照射70 ～80点.术后继续使用术前的降眼压药物,术后随访9个月,定期复查眼压、视力、眼前节炎症反应和房水流畅系数测定值,并用前房角镜检查房角的开放情况.结果 本组术眼术后1d,1周,1、3、6、9个月的平均眼压分别为(18.78±4.87)、(18.83±3.95)、(19.78±4.48)、(19.63±3.68)、(19.11±3.36)、(21.17±3.14)mmHg,与术前眼压值(24.78±4.48)mmHg比较,术后1～9个月明显下降,差异均有统计学意义(P＜0.05).各时间点患眼日平均用药指数分别为(1.63±0.85)、(1.23±1.01)、(1.25±0.98)、(1.21±1.02)、(1.22±0.86)、(1.69±0.53)分,术后1周,1、3、6个月与术前值的(1.62±0.66)分比较,差异均有统计学意义(P=0.020、0.026、0.020、0.031).术后即刻可见睫状体充血和前房闪辉,1周后自然消退.16眼术前和术后3个月的平均房水流畅系数(C值)分别为0.11±0.09和0.23±0.15,差异有统计学意义(P=0.002).结论 SLT能够安全有效地降低部分闭角型青光患者的眼压,但其前提是必须有1/2周的虹膜小梁角是开放的.     

选择性激光小梁成形术治疗原发性开角型青光眼观察

目的 观察选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)的有效性和安全性.方法 原发性开角型青光眼患者23例36只眼,原发性开角型青光眼小梁切除术后高眼压患者6例6只眼,眼压(25.15±8.23)mmHg,倍频Q-开关532nmNd:YAG激光,单脉冲,脉冲时间3ns,光斑直径400um.应用房角镜鼻侧或颞侧房角180°范围内进行治疗,能量0.60～1.50mJ,点数(50±5)点.测量术后第1h眼压,术后1d,1周,2周,3周,1月,3月,6月,1年随访,对比术前术后眼压、最佳矫正视力、视野及杯盘比变化.结果 患者术前眼压(25.15±8.23)mmHg,术后1h为(18.14±5.36)mmHg,1d为(14.52±3.63)月mmHg,1周为(18.12±2.38)mmHg,1月为(17.96±3.35)mmHg,3月为(18.05±2.58)mmHg,6月为(17.48±2.12)mmHg,1年为(17.89±3.13)mmHg;术前患者杯盘比为0.65±0.30,术后1年为0.63±0.20;术前视力0.60±0.30,术后1年视力0.61±0.32;视野术前术后无变化.结论 选择性激光小梁成形术可以有效地降低原发性开角型青光眼及原发性开角型青光眼小梁切除术后高眼压患者的眼内压.

Abstract：

Objective To evaluate the efficiency and safety of selective laser trabeculoplasty (SLT) on primary open angle glaucoma (POAG). Methods A total of 36 eyes of 23 patients with POAG, 6 eyes of 6POAG patients with high intraocular pressure (IOP) after SLT therapy, IOP (25.15± 8.23) mmHg, and they were treated with a frequency-doubled, Q-switched Nd:YAG laser (532nm). A total of approximately 50± 5nonoverlaping spots were placed over 180° of the gonioscope nasal or temporal side at the energy levels ranging from 0.60-1.50m J/pulses. Every patient was asked for follow-up at 1h, 1d, 1w, 2w, 3w, 1m, 3m, 6m and 1yafter treatment. IOP, visual acuity, C/D and visual field were examined each time. Results The pretreatment IOP was (25.15± 8.23) mmHg. At the end of first 1h, 1d, 1w, 1m, 6m, 1y of the follow-up, the IOP was (18.14± 5.36)mmHg, (14.52± 3.63)mmHg, (17.96± 3.35)mmHg, (18.05± 2.58)mmHg, (17.48± 2.12)mmHg, (17.89± 3.13) mmHg respectively. The pretreatment cup/disc ratio was 0.65± 0.30, at the end of 1y of the follow-up, the C/D ratio was 0.63± 0.20; the pretreatment visual acuity was 0.60± 0.30, at the end of 1y of the follow-up, the visual was 0.61± 0.32, without significant difference in visual field. Conclusions SLT is a kind of effective method to treat POAG and special patients with high intraocular pressure after SLT therapy.     

选择性激光小梁成形术治疗原发性开角型青光眼的临床观察

目的:评价选择性激光小梁成形术(selective laser trabecu-loplasty,SLT)治疗原发性开角型青光眼的疗效和安全性及对不同条件原发性开角型青光眼治疗效果的差异。方法:原发性开角型青光眼46例46眼,分为A组(曾行小梁切除手术)21眼,B组(单纯药物治疗)14眼,C组(诊断未经治疗)11眼,经SLT治疗,随诊6mo,观察眼压、视力、视野等改变。结果:总体平均眼压在术后1d;1wk;1,3和6mo分别为(16.9±3.2),(18.7±3.3),(18.9±3.3),(19.8±3.2),(20.0±3.4)mmHg,均比术前眼压下降,具有显著性统计学差异,同一时间3组间比较无差异,术后反应均为一过性,1～3d内消失。结论:SLT治疗不同条件的原发性开角型青光眼均安全有效,长期疗效及重复治疗有待进一步观察。     

选择性激光小梁成形术治疗青光眼的研究进展

青光眼是世界第二位不可逆的致盲性眼病,一旦确诊,需要长期治疗。激光治疗已经成为青光眼治疗的3个主要手段之一,其中选择性激光小梁成形术（SLT）可选择性地作用于色素性小梁组织,使靶组织收缩,房水外流通畅,从而降低青光眼患者的眼压,但其具体作用机制复杂,目前尚不完全明确。由于其对小梁网组织破坏程度轻微,术后反应较轻,且对邻近组织无损伤,因此是一种安全且可重复治疗的手段,并且不会影响青光眼的下一步治疗。就SLT的原理及SLT临床应用的背景、临床疗效、治疗的安全性等进行综述。     

Our results of laser trabeculoplasty in simple glaucoma

In 24 patients with simple glaucoma in whom the IOP did not normalize under the conservative treatment the authors checked--between others--the Po, the outflow coefficient (C) and calculated Po/C. Laser trabeculoplasty was performed subsequently. The enumerated indexes were examined the day after surgery, then after the 1-st and 2-nd week, after a month and 2 months. In the majority of cases the coefficient C showed an improvement and normalization of the IOP distinctly seen till the 1-st month after operation. In subsequent observations 5 persons showed a renewed deterioration of the hydrodynamic conditions and the intervention was repeated leading to an improvement in 3 cases. In consideration of the lack of normalization of the IOP in 2 persons it was necessary to subject them to a surgical procedure.     

One-year follow-up of selective laser trabeculoplasty in open-angle glaucoma

BACKGROUND: Selective laser trabeculoplasty (SLT) targets the pigmented trabecular meshwork (TM) cells without damage to the adjacent non-pigmented tissue. A study was conducted to evaluate the efficacy and safety of SLT in the treatment of uncontrolled open-angle glaucoma. METHODS: In a prospective non-randomized study 44 eyes of 31 patients with uncontrolled open-angle glaucoma were treated with a frequency-doubled, Q-switched Nd:YAG laser. A total of approximately 50 spots were placed over 180 degrees of the TM at energy levels ranging from 0.7 to 0.9 mJ. Intraocular pressure (IOP) was measured 1, 2, and 24 h, 1 and 2 weeks and 1, 2, 3, 6, 9, and 12 months after treatment. RESULTS: The average pre-operative IOP was 25.6 (SD 2.6) mm Hg (range 22-34). The mean IOP reduction from baseline at 24 h, 3, 6 and 12 months was 7.1 mm Hg (SD 3.5) or 27.6%; 4.2 mm Hg (SD 3.5) or 16.4%; 4.7 mm Hg (SD 4.2) or 18.6%, and 4.4 mm Hg (SD 3.8) or 17.1%, respectively. The percent of eyes with IOP reduction of 3 mm Hg or more at 3, 6 and 12 months was 66, 78 and 62%. A pressure spike of 8 mm Hg or more was detected in 4 eyes (9.1%). Anterior chamber reaction was seen 1 h after SLT and was mild to moderate in 16 eyes (40.4%) and marked in 3 eyes (6.8%). CONCLUSIONS: SLT has shown reasonable efficacy in lowering IOP over 1-year follow-up, but there was a tendency for IOP to increase with a longer follow-up. Long-term follow-up studies with a large sample size are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT.     

Argon laser trabeculoplasty in the treatment of secondary glaucoma

Author refers a group of 17 eyes with secondary glaucomas with oper irido-corneal angle and treated by argon laser trabeculoplasty. The mean time of observation was 11.1 +/- 4.2 months after the operation. The intraocular pressure was compensated in 82.4% of eyes. The best results were achieved in the group of the exfoliative glaucomas and glaucomas present after the previous antiglaucomatic operations. The worst complication which occurred was the sympathetic ophthalmia.     

Matrix metalloproteinases and their tissue inhibitors after selective laser trabeculoplasty in pseudoexfoliative secondary glaucoma

Background  

The aim of this study was to assess changes in metalloproteinases (MMP-2) and tissue inhibitor of metalloproteinases (TIMP-2) following selective laser trabeculoplasty (SLT) in patients with pseudoexfoliative glaucoma (PEXG).     

选择性激光小梁成形术治疗激素性青光眼的疗效观察

目的：观察选择性激光小梁成形术（SLT）治疗激素性青光眼的临床疗效。 方法：对全身激素用药引起的激素性青光眼8例8眼进行房角全周SLT,其中男5例,女3例,年龄55~74（平均65）岁。激素的持续用药时间为11.5±3.3a,给药开始62±2.9a后眼压开始上升,使用2.9±0.5种类的抗青光眼药局部点眼。SLT术后继续点眼治疗和激素口服。 结果：平均眼压术前为26.8±5.1mmHg,SLT术后1mo为20.2±3.2mmHg,术后3mo为17.6±2.2mmHg,术后6mo为16.1±1.4mmHg。各时点的眼压值与术前眼压相比均有显著降低（P＜0.05）。 结论：SLT对于全身激素用药继发的激素性青光眼是一种安全而有效的治疗方法。     

选择性激光小梁成形术治疗开角型青光眼的研究进展

选择性激光小梁成形术（selective laser trabeculoplasty,SLT）采用倍频Q开关Nd：YAG激光,选择性作用于色素小梁网,而对邻近无色素小梁网不产生热损伤和凝固性破坏,目前对其作用机制的研究多集中于细胞因子的作用和后基因水平的改变.在SLT问世之初主要应用于原发性开角型青光眼的治疗,随着对其研究的深入,近年来SLT又被证明对其他类型的开角型青光眼也是安全有效的.在传统治疗参数的基础上,有学者认为低能量激光可以取得更好的疗效.目前已证实的影响SLT的降压效果的因素为基线眼压,基线眼压越高,效果越好.SLT术后常见的并发症包括一过性眼压升高、前房炎性反应以及结膜充血等.SLT的治疗能量与范围的选择、是否能替代传统的药物治疗而作为原发性开角型青光眼患者的初始治疗方法及其与药物配合治疗的最佳方案等问题仍需进一步研究探讨.     

选择性激光小梁成形术治疗青光眼的临床观察

目的评价选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)的疗效和安全性。方法选择局部用药眼压不能控制的原发性开角型青光眼20例(37眼),正常眼压性青光眼6例(10眼)。观察应用选择性激光小梁成形术后6个月眼压的变化。结果术后眼压平均降低幅度为4.86±2.14mmHg(24.04±10.21%),两组患眼的眼压在激光治疗后均有显著下降:开角型青光眼组术后6个月的眼压较术前平均下降5.44±2.32mmHg(24.90±11.09%);正常眼压性青光眼组平均下降2.71±1.12mmHg(19.06±7.19%)。术后暂时的眼压升高、前房炎症反应为常见的并发症。结论选择性激光小梁成形术具有降眼压效果明显、安全、实用、损伤小、可重复等特点,是治疗青光眼的一种较安全有效的方法。     

选择性激光小梁成形术治疗原发性青光眼的疗效

目的 评价选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗原发性开角型青光眼(primary open-angle glaucoma,POAG)和原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)的疗效及安全性.方法 收集我院眼科2007年1月至2008年1月就诊的原发性青光眼患者34例61眼,其中POAG组患者18例34眼,CPACG组患者16例27眼,2组均应用SLT治疗.观察患者术后1 h、1 d、1周、1个月、3个月、6个月的眼压以及术后6个月视力、视野、房角及角膜内皮细胞数等变化.结果 2组患者眼压在激光治疗后均有显著下降,POAG组患者术前平均眼压为(25.2±2.2)mmHg(1 kPa=7.5 mmHg),术后1 h、1 d、1周、1个月、3个月、6个月眼压分别为(28.9±1.3)mmHg、(17.0±1.9)mmHg、(19.9±1.7)mmHg、(20.1±1.8)mmHg、(18.2±2.1)mmHg、(18.0±2.1)mmHg.CPACG组患者术前平均眼压为(24.9±2.1)mmHg,术后对应时间点眼压分别为(29.3±1.6)mmHg、(16.9±2.0)mmHg、(20.3±1.8)mmHg、(19.3±1.9)mmHg、(20.1±2.0)mmHg、(18.9±2.2)mmHg.2组术后1 d、1周、1个月、3个月、6个月的眼压与术前相比明显下降,差异均有统计学意义(P均<0.05).术后1 d眼压下降最明显,术后一过性眼压升高为最常见的并发症.术后6个月2组患者随访视力、前房角、视野、角膜内皮细胞计数与术前比较均无明显变化.结论 SLT可以安全有效地降低POAG和房角大部分开放的CPACG患者的眼压.