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经巩膜二极管激光睫状体光凝术联合艾哈迈德房角植入术治疗犬原发性青光眼:51例(1996 - 2004年)

Combined transscleral diode laser cyclophotocoagulation and Ahmed gonioimplantation in dogs with primary glaucoma: 51 cases (1996-2004).

作者信息

Sapienza John S, van der Woerdt Alexandra

机构信息

Long Island Veterinary Specialists, 163 South Service Road, Plainview, NY 11803, USA.

出版信息

Vet Ophthalmol. 2005 Mar-Apr;8(2):121-7. doi: 10.1111/j.1463-5224.2005.00356.x.

Abstract

OBJECTIVE

To evaluate the combined diode laser cycloablation procedure and adjunctive Ahmed gonioimplant use in dogs with primary glaucoma.

DESIGN

Retrospective study.

ANIMALS

48 dogs, 51 eyes with primary glaucoma.

PROCEDURE

Medical records from two large private clinical ophthalmology services were reviewed. Signalment, duration of glaucoma, gonioscopic evaluation, laser power and duration settings, immediate postoperative and final intraocular pressure and visual results, short and long-term visual outcome, and surgical complications were recorded.

RESULTS

The age range of affected dogs was 3.0-14.0 years, with a mean age of 7.5 +/- 2.6 years. Eleven pure breeds were represented, with the most common being the American Cocker Spaniel. The sex distribution was 22 neutered males, 1 intact male, 23 spayed females, and 2 intact female dogs. The right eye was affected in 33 cases, and the left eye in 18 cases. The average total joules, which was administered with the diode laser, was 109.6 +/- 23.6 J. Immediate surgical complications included fibrin formation in the anterior chamber (15), corneal ulcers (4), hyphema (7), and focal retinal detachment (1). Long-term complications included cataract formation (8 total, 2 of which were significant, vision-threatening), elevated intraocular pressure (IOP) (6), unstable gonioimplant (1), and glaucoma recurrence (14). Additional surgeries performed on the eyes over the course of study included: intrascleral prosthesis (4), enucleation (1), resection of fibrotic scar tissue (5), and repeat laser cycloablation (8). The dogs were examined for a mean follow-up time of 17.6 months (range: 2-83 months postoperatively). Twenty-nine cases were followed greater than one year. Vision was maintained in 42/51 eyes (82%) in the immediate short-term of this study. In all cases included in the study, good control of IOP was achieved in 39/51 (76%) of eyes, and IOP was poor or uncontrolled in 12/51 (24%) of eyes. Twenty out of 41 eyes (49%) maintained fair to excellent vision six months after surgery. Twelve months postoperative observations demonstrated that 12/29 (41%) of the eyes were still visual.

CONCLUSIONS

In primary glaucoma, the combined procedure of laser diode cyclophotocoagulation and Ahmed valve implant was associated with return or maintenance of vision in 42/51 eyes (82%) in the immediate short-term of this study, and a long-term IOP control in 39/51 (76%) of the cases, with 12/29 eyes (41%) visual after 12 months.

摘要

目的

评估联合二极管激光睫状体光凝术及辅助使用艾哈迈德房角植入物治疗原发性青光眼犬的效果。

设计

回顾性研究。

动物

48只犬,51只患原发性青光眼的眼睛。

方法

回顾了两家大型私立临床眼科机构的病历。记录动物特征、青光眼病程、前房角镜评估、激光功率和持续时间设置、术后即刻及最终眼压和视力结果、短期和长期视力转归以及手术并发症。

结果

患犬年龄范围为3.0 - 14.0岁,平均年龄为7.5 ± 2.6岁。涉及11个纯种犬种,最常见的是美国可卡犬。性别分布为22只去势雄性犬、1只未去势雄性犬、23只去势雌性犬和2只未去势雌性犬。右眼患病33例,左眼患病18例。二极管激光的平均总能量为109.6 ± 23.6焦耳。即刻手术并发症包括前房内纤维蛋白形成(15例)、角膜溃疡(4例)、前房积血(7例)和局灶性视网膜脱离(1例)。长期并发症包括白内障形成(共8例,其中2例严重,威胁视力)、眼压升高(6例)、房角植入物不稳定(1例)和青光眼复发(14例)。在研究过程中对眼睛进行的其他手术包括:巩膜内植入物(4例)、眼球摘除术(1例)、纤维化瘢痕组织切除术(5例)和重复激光睫状体光凝术(8例)。犬的平均随访时间为17.6个月(范围:术后2 - 83个月)。29例随访时间超过1年。在本研究的短期即刻,42/51只眼睛(82%)的视力得以维持。在纳入研究的所有病例中,39/51只眼睛(76%)眼压得到良好控制,12/51只眼睛(24%)眼压控制不佳或未得到控制。41只眼睛中有20只(49%)在术后6个月维持了尚可至极佳的视力。术后12个月的观察表明,12/29只眼睛(41%)仍有视力。

结论

在原发性青光眼中,本研究短期即刻,激光二极管睫状体光凝术与艾哈迈德瓣膜植入联合手术使42/51只眼睛(82%)的视力得以恢复或维持,39/51例(76%)实现了长期眼压控制,12个月后12/29只眼睛(41%)仍有视力。

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