二极管激光经巩膜睫状体光凝术治疗穿透性角膜移植术后难治性青光眼

Diode laser transscleral cyclophotocoagulation for the treatment of refractory glaucoma after penetrating keratoplasty.

作者信息

Ocakoglu Ozcan, Arslan Osman Sevki, Kayiran Alp

机构信息

Glaucoma Division, Ophthalmology Department, Istanbul University, Medical School of Cerrahpasa, Istanbul, Turkey.

出版信息

Curr Eye Res. 2005 Jul;30(7):569-74. doi: 10.1080/02713680590968529.

DOI:10.1080/02713680590968529

PMID:16020291

Abstract

PURPOSE

To evaluate the effect and safety of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with refractory glaucoma after penetrating keratoplasty (PK).

METHODS

Diode laser TSCPC was performed on 32 eyes of 32 patients with secondary glaucoma after penetrating keratoplasty. The mean follow-up period was 11.4 +/- 3.8 months (range, 6-20 months). The intraocular pressure (IOP), number of glaucoma medications, graft status, side effects, and complications of the procedure were all recorded during the follow-up period. The treatment was considered successful if after one cyclodiode treatment the IOP could be reduced to or below 22 mmHg with or without medication. The success rate of the diode laser treatment was analyzed by the Kaplan-Meier survival analysis method during the 6th and 12th months of the follow-up period and the end of the study. The decrease in drug requirement after laser treatment was analyzed by the Wilcoxon nonparametric test. Statistical significance was set at p < 0.05.

RESULTS

During the follow-up period, diode laser TSCPC reduced the IOP significantly. Our cumulative success rate was 56% at the end of the study. Cyclodiode treatment resulted in an IOP less than 22 mmHg in 97% of the eyes on the 6th month and 72% of the eyes on the 12th month with or without medication. The total retreatment rate of the study was 44%. More than one treatment was necessary, 8 times in the 1st month, 9 times in the 3rd month, 5 times in the 6th month and 3 times in the 12th month. The average number of antiglaucomatous drugs used was 2.8 before surgery and 1.2 after the 12th month follow-up period (p < 0.05). No eyes with graft failure after treatment were present. Visual acuity improved (> 2 Snellen lines of acuity) in two eyes and remained the same in the others. No serious side effects such as phthisis bulbi or hypotonia were observed.

CONCLUSIONS

Diode laser TSCPC appears to be a safe and effective procedure for the treatment of uncontrolled glaucoma secondary to penetrating keratoplasty.

摘要

目的

评估二极管激光经巩膜睫状体光凝术（TSCPC）治疗穿透性角膜移植术（PK）后难治性青光眼的疗效和安全性。

方法

对32例穿透性角膜移植术后继发青光眼患者的32只眼进行二极管激光TSCPC治疗。平均随访时间为11.4±3.8个月（范围6 - 20个月）。随访期间记录眼压（IOP）、青光眼药物使用数量、植片状态、手术副作用及并发症。若一次睫状体光凝治疗后眼压在使用或不使用药物的情况下可降至或低于22 mmHg，则认为治疗成功。采用Kaplan - Meier生存分析方法分析随访第6个月、12个月及研究结束时二极管激光治疗的成功率。采用Wilcoxon非参数检验分析激光治疗后药物需求的减少情况。设定统计学显著性为p < 0.05。

结果

随访期间，二极管激光TSCPC显著降低了眼压。研究结束时我们的累积成功率为56%。睫状体光凝治疗使97%的眼在第6个月时眼压低于22 mmHg，72%的眼在第12个月时眼压低于22 mmHg，无论是否使用药物。该研究的总再次治疗率为44%。需要进行不止一次治疗，第1个月8次，第3个月9次，第6个月5次，第12个月3次。术前平均使用抗青光眼药物数量为2.8种，随访第12个月后为1.2种（p < 0.05）。治疗后无植片失败的眼。2只眼视力提高（视力提高> 2行Snellen视力表），其他眼视力保持不变。未观察到如眼球痨或低眼压等严重副作用。