中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
2期
168-171
,共4页
糖皮质激素/不良反应%眼压/药物作用%激光疗法/方法%回顾性研究%选择性激光小梁成形术
糖皮質激素/不良反應%眼壓/藥物作用%激光療法/方法%迴顧性研究%選擇性激光小樑成形術
당피질격소/불량반응%안압/약물작용%격광요법/방법%회고성연구%선택성격광소량성형술
Glucocorticoid/adverse effect%Intraocular pressure/drug effect%Laser therapy/method%Retrospective study%Selective laser trabeculoplasty
背景 糖皮质激素在眼科治疗过程中的应用日益广泛,而糖皮质激素的局部长期应用存在诱发青光眼的潜在危险.近年来的研究表明,选择性激光小梁成形术(SLT)可用于糖皮质激素性青光眼的治疗,但其疗效需要进一步评价. 目的 观察SLT治疗糖皮质激素性青光眼的降眼压效果. 方法 采用回顾性系列病例分析设计,对经复旦大学眼耳鼻喉科医院眼科确诊的糖皮质激素性青光眼患者9例9眼行360°SLT治疗,年龄25～ 52岁.其中5例5眼为准分子激光角膜原位磨镶术(LASIK)术后长期(4～6周)使用糖皮质激素滴眼液所致,4例4眼因视网膜中央静脉阻塞(CRVO)黄斑水肿接受玻璃体腔内注射0.1 ml曲安奈德(4.O mg)所致.在接受SLT治疗前,虽然所有患者均无青光眼和高眼压病史,但这些患者使用糖皮质激素后出现了高眼压,所以均接受了最大可耐受剂量的降眼压治疗.所有患者行SLT治疗前停止使用糖皮质激素2 ～12个月,术前眼压为35 ～44 mmHg(1 mmHg=0.133 kPa).患者随访6个月,观察术眼治疗前及治疗后不同时间点的眼压变化.采用重复测量方差分析法分析治疗后各时间点术眼眼压的差异. 结果 所有患者均只接受1次SLT治疗.SLT治疗前患者的平均眼压为(40.0±2.9)mmHg,治疗后1h、1周及1、3、6个月的眼压分别为(37.9±8.1)、(34.9±5.9)、(27.6±6.7)、(21.6±6.9)和(17.9±2.9) mmHg.治疗后1、3、6个月时的平均眼压均较术前明显下降,差异均有统计学意义(P＜0.05).本组患者中2例2眼因眼压控制不良分别于SLT治疗后1个月和3个月接受了滤过性手术,SLT治疗后6个月,1例患者仍然需要使用2种局部降眼压药物控制眼压,6例患者无需使用降眼压药物.结论 在纳入的9眼中,SLT有效降低了6眼糖皮质激素性青光眼患眼的眼压,降眼压疗效出现于治疗后1个月,随访期内眼压保持稳定.
揹景 糖皮質激素在眼科治療過程中的應用日益廣汎,而糖皮質激素的跼部長期應用存在誘髮青光眼的潛在危險.近年來的研究錶明,選擇性激光小樑成形術(SLT)可用于糖皮質激素性青光眼的治療,但其療效需要進一步評價. 目的 觀察SLT治療糖皮質激素性青光眼的降眼壓效果. 方法 採用迴顧性繫列病例分析設計,對經複旦大學眼耳鼻喉科醫院眼科確診的糖皮質激素性青光眼患者9例9眼行360°SLT治療,年齡25～ 52歲.其中5例5眼為準分子激光角膜原位磨鑲術(LASIK)術後長期(4～6週)使用糖皮質激素滴眼液所緻,4例4眼因視網膜中央靜脈阻塞(CRVO)黃斑水腫接受玻璃體腔內註射0.1 ml麯安奈德(4.O mg)所緻.在接受SLT治療前,雖然所有患者均無青光眼和高眼壓病史,但這些患者使用糖皮質激素後齣現瞭高眼壓,所以均接受瞭最大可耐受劑量的降眼壓治療.所有患者行SLT治療前停止使用糖皮質激素2 ～12箇月,術前眼壓為35 ～44 mmHg(1 mmHg=0.133 kPa).患者隨訪6箇月,觀察術眼治療前及治療後不同時間點的眼壓變化.採用重複測量方差分析法分析治療後各時間點術眼眼壓的差異. 結果 所有患者均隻接受1次SLT治療.SLT治療前患者的平均眼壓為(40.0±2.9)mmHg,治療後1h、1週及1、3、6箇月的眼壓分彆為(37.9±8.1)、(34.9±5.9)、(27.6±6.7)、(21.6±6.9)和(17.9±2.9) mmHg.治療後1、3、6箇月時的平均眼壓均較術前明顯下降,差異均有統計學意義(P＜0.05).本組患者中2例2眼因眼壓控製不良分彆于SLT治療後1箇月和3箇月接受瞭濾過性手術,SLT治療後6箇月,1例患者仍然需要使用2種跼部降眼壓藥物控製眼壓,6例患者無需使用降眼壓藥物.結論 在納入的9眼中,SLT有效降低瞭6眼糖皮質激素性青光眼患眼的眼壓,降眼壓療效齣現于治療後1箇月,隨訪期內眼壓保持穩定.
배경 당피질격소재안과치료과정중적응용일익엄범,이당피질격소적국부장기응용존재유발청광안적잠재위험.근년래적연구표명,선택성격광소량성형술(SLT)가용우당피질격소성청광안적치료,단기료효수요진일보평개. 목적 관찰SLT치료당피질격소성청광안적강안압효과. 방법 채용회고성계렬병례분석설계,대경복단대학안이비후과의원안과학진적당피질격소성청광안환자9례9안행360°SLT치료,년령25～ 52세.기중5례5안위준분자격광각막원위마양술(LASIK)술후장기(4～6주)사용당피질격소적안액소치,4례4안인시망막중앙정맥조새(CRVO)황반수종접수파리체강내주사0.1 ml곡안내덕(4.O mg)소치.재접수SLT치료전,수연소유환자균무청광안화고안압병사,단저사환자사용당피질격소후출현료고안압,소이균접수료최대가내수제량적강안압치료.소유환자행SLT치료전정지사용당피질격소2 ～12개월,술전안압위35 ～44 mmHg(1 mmHg=0.133 kPa).환자수방6개월,관찰술안치료전급치료후불동시간점적안압변화.채용중복측량방차분석법분석치료후각시간점술안안압적차이. 결과 소유환자균지접수1차SLT치료.SLT치료전환자적평균안압위(40.0±2.9)mmHg,치료후1h、1주급1、3、6개월적안압분별위(37.9±8.1)、(34.9±5.9)、(27.6±6.7)、(21.6±6.9)화(17.9±2.9) mmHg.치료후1、3、6개월시적평균안압균교술전명현하강,차이균유통계학의의(P＜0.05).본조환자중2례2안인안압공제불량분별우SLT치료후1개월화3개월접수료려과성수술,SLT치료후6개월,1례환자잉연수요사용2충국부강안압약물공제안압,6례환자무수사용강안압약물.결론 재납입적9안중,SLT유효강저료6안당피질격소성청광안환안적안압,강안압료효출현우치료후1개월,수방기내안압보지은정.
Background Glucocorticoid drugs have been used increasingly in ophthalmology.It has been established that glucocorticoid are associated with a rise in intraocular pressure (IOP) and the development of glaucoma.Selective laser trabeculoplasty (SLT) is thought to be effective in treating patients with glucocorticoidinduced elevated IOP.Objective This study was to assess the efficacy of SLT in lowering IOP in patients with glucocorticoid-induced ocular hypertension.Methods A retrospective case series study was adopted.SLT around 360° chamber angle was performed in 9 eyes of 9 patients with glucocorticoid-induced glaucoma in Eye & ENT Hospital of Fudan University,including 5 eyes of 5 patients owing to use of glucocorticoid eye drops for long-term after laser in situ keratomileusis (LASIK) and 4 eyes of 4 patients who received intravitreal injection of 0.1 ml triamcinolone acetonide (TA) (4.0 mg) for macular edema induced by central retinal vein occlusion(CRVO).All of the patients were lack of preexisting glaucoma or ocular hypertension and underwent unsuccessful maximum tolerated medical therapy before SLT treatment.The base IOP was 35-44 mmHg and glucocorticoid drugs were ceased for 2-12 months prior to the SLT.The patients were followed-up for 6 months.IOP was measured and recorded before and 1 hour,1 week,1 month and 3 months,6 months after SLT.The difference of IOP was compared by repeated measures analysis of variance and multiple comparison analysis.Results All the patients received single SLT operation.The mean IOP was (40.0±2.9) mmHg before operation,but the IOP was (37.9±8.1),(34.9±5.9),(27.6±6.7),(21.6±6.9) and (17.9±2.9)mmHg 1 hour,1 week,1 month,3 months and 6 months after SLT.The IOP at 1 month,3 months and 6 months after SLT were significantly lower than that before operation (all at P＜0.05).Two patients received a filtration surgery for uncontrolled IOP at 1 month and 3 months after SLT respectively,and another patient still used 2 kinds of lowing-IOP eye drops until the end of following-up duration.Conclusions SLT reduce IOP in 6 eyes of 9 patients with glucocorticoid-induced increased IOP from the initial 1 month through 6 months after SLT.
