选择性激光小梁成形术研究进展

激光治疗是青光眼治疗的重要手段之一。选择性激光小梁成形术（SLT）选择性作用于小梁网的色素细胞,避免了对周边组织的损害,同时可起到一定程度的降眼压作用,其机制复杂,目前尚不完全明确。相关研究显示,对于开角型青光眼,SLT具有与氩激光小梁成形术（ALT）以及药物治疗相似的效果,在部分复杂病例及闭角型青光眼中也显示了一定的降眼压作用,术后反应较轻,且可以重复操作,将会越来越受到重视。就SLT的原理、临床应用进展及其并发症等进行综述。     

选择性激光小梁成形术的研究进展

青光眼是全球第一大不可逆的致盲性眼病,通过药物、激光和手术降低眼压是治疗青光眼的基本方法。选择性激光小梁成形术(SLT)是应用倍频Q开关、波长532 nm的掺钕钇铝石榴石激光,选择性作用于色素性小梁组织达到降低眼压目的。近30年来,SLT在不引起小梁网凝固性损伤的情况下可以降低眼压,已经逐渐成为治疗以原发性开角型青光眼为主的各种类型青光眼的初始治疗或替代治疗方法之一。本文中笔者就SLT的历史沿革、降眼压机制、临床应用、初始治疗、重复治疗、治疗成功的预测因素、并发不良反应、成本效益及健康相关生活质量等方面进行综述。     

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.     

选择性激光小梁成形术189眼治疗观察

目的观察选择性激光小梁成形术(SLT)作为原发性开角型青光眼、视网膜静脉阻塞伴开角型青光眼、进展性近视伴开角型青光眼、正常眼压性青光眼、前部缺血性视神经病变改善眼压首选治疗的安全性和有效性。方法分别对原发性开角型青光眼患者48例79只眼,视网膜静脉阻塞伴开角型青光眼患者26例36只眼,正常眼压性青光眼患者12例24只眼,前部缺血性视神经病变(AION)患者28例32只眼,进展性近视伴开角型青光眼患者14例18只眼,总计128例189只眼进行SLT治疗。结果以患者术后眼压较术前眼压下降≥3mmHg为有效,分别计算出患者术后2小时、1月、3月、6月、12月的有效率,总有效率分别为93.65%、97.48%、95.65%、94.57%、91.49%。结论SLT有显著的降眼压效果、安全、损伤小、实用、简便、科学。     

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临床疗效观察

目的:评价选择性激光小梁成形术对进展期青光眼的治疗效果。方法:对26例36眼房角开放的进展期的开角型青光眼和继发性青光眼患者,选用激光小梁成形术进行治疗。测量激光前及激光术后不同时间的眼压并进行统计学分析,观察激光前后视力、眼底、视野和局部用药量的变化。结果:患者术前眼压24.44±5.55mmHg,术后1h为24.22±6.32mmHg,无统计学差异;术后1d;1wk;1,2,3,6,9,12mo眼压下降,与术前有统计学差异(P<0.01)。术前患者杯盘比为0.75±0.16,术后6mo为0.76±0.14,无统计学差异;术后12mo为0.77±0.15,与术前比较有统计学差异(P<0.05)。术前用药平均为1.69±0.58种,术后6mo内用量下降,有统计学差异;9,12mo用药量上升,与术前比较无统计学差异(P<0.05)。视力、视野术前术后无进展。结论:激光小梁成形术可以有效地降低进展期青光眼患者的眼内压。     

选择性激光小梁成形术治疗开角型青光眼的研究进展

激光用于青光眼的治疗已有近35a的历史。近年来,选择性激光小梁成形术(SLT)以其安全、有效降眼压、并发症少等优点逐渐成为开角型青光眼的首选治疗。选择性激光小梁成形术是治疗开角型青光眼的一种新型激光手术,它应用倍频Q-开关、波长532nm的Nd:YAG激光,选择性作用于色素性小梁组织达到降低眼压目的。与氩激光小梁成形术(argonlasertrabeculoplasty,ALT)相比,两者降眼压效果相似,但是相对于ALT对小梁网的凝固性损伤,SLT选择性作用于色素性小梁细胞,无凝固性损伤,对小梁网组织轻微破坏,是一种安全且可重复治疗的手段。     

选择性激光小梁成形术

选择性激光小梁成形术（SLT）通过选择性作用于色素性小梁网以改善房水的流出通道，从而达到降低眼内压，治疗原发性开角型青光眼的目的。研究表明，SLT无热损伤、可重复治疗、降眼压疗效显而安全，是治疗原发性开角型青光眼的又一新措施。     

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.

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.