Vergés Carlos, Llevat Elvira, Bardavio Javier
Department of Ophthalmology, Institut Universitari Dexeus, Barcelona, Spain.
J Cataract Refract Surg. 2002 May;28(5):758-65. doi: 10.1016/s0886-3350(01)01257-3.
To study the clinical effectiveness of deep sclerectomy using the erbium:YAG (Er:YAG) laser in patients with open-angle glaucoma (OAG).
Department of Ophthalmology, Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.
This nonrandomized prospective clinical study was performed in 46 consecutive eyes with OAG. Seventeen patients had not received any treatment for glaucoma. Eight had received 1 medication; 14, 2 medications; and 7, 3 medications. The mean duration of treatment was 18.3 months +/- 9.4 (SD). After mitomycin-C 0.02% was administered for 2 minutes, a superficial 4.0 mm x 4.0 mm scleral flap was created and a deep 3.0 mm x 3.0 mm scleral ablation was performed with the Er:YAG laser. Schlemm's canal was removed, and the cornea was dissected to Descemet's membrane until aqueous humor percolated. The scleral flap and conjunctiva were closed. Postoperative follow-up examinations were done at 1, 3, and 7 days, 2, 3, and 4 weeks, and then every 3 months up to 15 months.
The mean preoperative intraocular pressure (IOP) was 28.3 +/- 6.1 mm Hg. The mean postoperative IOP was 14.1 +/- 3.5 mm Hg at 24 hours, 16.3 +/- 4.2 mm Hg at 3 months, and 15.3 +/- 2.7 mm Hg at 15 months (P <.001). There were no statistically significant differences in IOP by sex or age. There was a statistically significant difference between patients receiving no medication and those who received more than 2 medications and a treatment period longer than 1 year preoperatively (P <.006). The presence of a filtering bleb was associated with a longer period of decreased IOP (P <.007). The success rate (IOP < or =18 mm Hg without medication) was 93.47% at 1 month and 84.78% at 15 months. The number of complications was significantly lower than in previous reports of trabeculectomy. One patient lost 2 lines of visual acuity because of cystoid macular edema.
Deep sclerectomy using the Er:YAG laser was safe and effective in eyes with OAG. More studies are needed to analyze the mechanism of lowering IOP.
研究使用铒激光（Er:YAG）进行深层巩膜切除术治疗开角型青光眼（OAG）患者的临床疗效。
西班牙巴塞罗那自治大学德克塞斯大学医院眼科。
对46例连续的开角型青光眼患者的眼睛进行了这项非随机前瞻性临床研究。17例患者未接受过任何青光眼治疗。8例患者曾使用过1种药物；14例使用过2种药物；7例使用过3种药物。平均治疗时间为18.3个月±9.4（标准差）。在使用0.02%丝裂霉素C处理2分钟后，制作一个4.0毫米×4.0毫米的浅层巩膜瓣，并用Er:YAG激光进行3.0毫米×3.0毫米的深层巩膜消融。切除施莱姆管，并将角膜剖切至后弹力层，直到房水渗出。关闭巩膜瓣和结膜。术后随访检查分别在术后1、3和7天，2、3和4周进行，然后每3个月进行一次，直至15个月。
术前平均眼压（IOP）为28.3±6.1毫米汞柱。术后24小时平均眼压为14.1±3.5毫米汞柱，3个月时为16.3±4.2毫米汞柱，15个月时为15.3±2.7毫米汞柱（P<.001）。眼压在性别或年龄方面无统计学显著差异。术前未用药患者与使用超过2种药物且治疗时间超过1年的患者之间存在统计学显著差异（P<.006）。滤过泡的存在与眼压降低的时间延长相关（P<.007）。成功率（不用药时眼压≤18毫米汞柱）在1个月时为93.47%，15个月时为84.78%。并发症数量明显低于先前小梁切除术的报告。1例患者因黄斑囊样水肿视力下降了2行。
使用Er:YAG激光进行深层巩膜切除术治疗开角型青光眼是安全有效的。需要更多研究来分析眼压降低的机制。
