CAJ | 학술논문

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.
배경 선택성격광소량성형술(SLT)치료원발성개각형청광안(POAG)적안전성화유효성이득도인문엄범적인동,단흘금위지SLT치료폐각형청광안적연구교소,기효과화안전성상대림상관찰증실.목적 평개SLT치료잔여원발성폐각형청광안(PACG)적료효급안전성.방법 채용병례관찰성연구설계.공납입경격광주변홍막성형술화/혹격광홍막주변절제술치료후전방각개방단안압불능강지정상적폐각형청광안환자23례33안,술전평균안압(24.78±4.48)mmHg,일평균용약지수(1.62±0.66)분.소유안적전방각능간도소량망적범위약180°.용Q개관배빈Nd:YAG격광궤재환안개방적전방각조사소량망,재180°범위내조사70 ～80점.술후계속사용술전적강안압약물,술후수방9개월,정기복사안압、시력、안전절염증반응화방수류창계수측정치,병용전방각경검사방각적개방정황.결과 본조술안술후1d,1주,1、3、6、9개월적평균안압분별위(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,여술전안압치(24.78±4.48)mmHg비교,술후1～9개월명현하강,차이균유통계학의의(P＜0.05).각시간점환안일평균용약지수분별위(1.63±0.85)、(1.23±1.01)、(1.25±0.98)、(1.21±1.02)、(1.22±0.86)、(1.69±0.53)분,술후1주,1、3、6개월여술전치적(1.62±0.66)분비교,차이균유통계학의의(P=0.020、0.026、0.020、0.031).술후즉각가견첩상체충혈화전방섬휘,1주후자연소퇴.16안술전화술후3개월적평균방수류창계수(C치)분별위0.11±0.09화0.23±0.15,차이유통계학의의(P=0.002).결론 SLT능구안전유효지강저부분폐각형청광환자적안압,단기전제시필수유1/2주적홍막소량각시개방적.
Background Selective laser trabeculoplasty(SLT)has been widely accepted for the treatment of open-angle glaucoma.However,there are few reports about its application in treating angle-closure glaucoma so far.Objective This study was to clinically evaluate the safety and efficacy of selective laser trabeculoplasty for primary angle-closure glaucoma with opened anterior angle follow-up surgery.Methods A case-observational design was adopted in this study.A total of 33 eyes from 23 angle-closure glaucomatous patients with opened 180° angle were enrolled.All the patients understood this trial and written informed consent was obtained prior to the medical treatment.The average preoperative intraocular pressure(IOP)and number of medication were(23.07±4.01)mmHg and 1.52±0.66,respectively.A frequency doubled Q-switched Nd:YAG laser was used to irradiate the trabecular meshwork with 70-80 laser spots over 180°.The same preoperative anti-glaucoma drugs were topically administered during the follow-up period.Visual acuity,IOP,slit lamp examination,gonioscopy and the coefficient of outflow facility were regularly assessed and performed after laser surgery.Results The IOP values of the 33 eyes were(18.78±4.87)mmHg,(18.83±3.95)mmHg,(19.78±4.48)mmHg,(19.63±3.68)mmHg,(19.11±3.36)mmHg,and(21.17±3.14)mmHg 1 day,l week,and 1,3,6,9 months after operation,showing significant decline in comparison with preoperation(P＜0.01).The mean drug uses were 1.63±0.85,1.23±1.01,1.25±0.98,1.21±1.02,1.22±0.86,and 1.69±0.53 at the same time point after operation,respectively,and significant differences were found 1 week,1,3,6 months in postoperation in comparison with preoperation(P =0.020,0.026,0.020,0.031).Ciliary congestion and aqueous flare naturally disappeared 1 week after surgery.The coefficients of outflow facility were 0.11±0.09 and 0.23±0.15,respectively at pretreatment and 3 months after SLT with a statistically significant difference (P=0.002).Conclusions Selective laser trabeculoplasty is effective and safe for angle-closure glaucoma.However,it is essential to have 1/2 circle of anterior chamber open for SLT in angle-closure glaucoma.