Sicáková S, Výborný P
Ocní klinika 1. lékarské fakulty Univerzity Karlovy a Ustrední vojenské nemocnice, Praha.
Cesk Slov Oftalmol. 2010 Nov;66(5):204-8.
The authors present results of their own modification of selective laser trabeculoplasty in primary open angle glaucoma and other groups of glaucoma using the laser machine Laserex Tango (wave length 532 nm, Q-switched, Nd-YAG laser, pulse duration 3 ns [nanoseconds], target diameter 400 Um, 80 burns, extension? of the circumference of the anterior chamber angle, power 1.0 mJ). The intraocular pressure was measured by means of the non-contact tonometer Nidek 2000, calibrated according to the current legislation. In the first group, the changes of the intraocular pressure (IOP) in primary open angle glaucoma in 106 eyes of 75 patients, aged 21 - 80 years, with seven controls during 36 months were followed-up. Remarkable decrease of the IOP from the baseline of 20.7 +/- 4.6 mm Hg to 17.5 +/- 3.1 mm Hg (one month - M1), 17.8 +/- 3.5 mm Hg (3 months - M3), 17.7 +/- 3.1 mm Hg (6 months - M6), 17.8 +/- 2.7 mm Hg (12 months - M12), 17.9 + 2.6 mm Hg (24 months - M24), and 18.2 + 3.1 mm Hg (36 months - M36) was recorded. The average IOP decrease by 3.2 mm Hg (decrease by 15.5%) between the baseline and the values after 1 months of treatment was proven to be statistically significant (p-value <0.0001) as well as the average difference of 2.9 mm Hg (decrease by 14.0%), 3.0 mm Hg (decrease by 14.5%), 2.9 mm Hg (decrease by 14.0%), 3.0 mm Hg (decrease by 14.5%), 2.9 mm Hg (decrease by 14.0%), 2.8 mm Hg (decrease by 13.5%), and 2.5 mm Hg (decrease by 12.1%) among the baseline IOP values and the IOP values measured successively after 3, 6, 12, 24, and 36 months. In the second group, the IOP and treatment changes were followed-up in patients with the primary open angle glaucoma with 3 controls during 36 months in 420 eyes of 263 patients (age 21 - 84 years). In the end of three years follow-up period, in 234 eyes the simplified monotherapy remained, in 146 eyes the treatment was the same as before the laser surgery, in 40 cases it was necessary to perform re-SLT, and out of this number, in 19 cases the trabeculectomy was consequently performed due to unsatisfactory IOP compensation. It was recorded remarkable IOP values decrease from the baseline 20.8 +/- 4.1 mm Hg to 18.0 +/- 2.8 mm Hg (12 months - M12), 17.7 +/- 2.6 mm Hg (24 months - M24), and 17.7 +/- 3.1 mm Hg (36 months - M36).The average IOP lowering by 2.8 mm Hg (decrease by 13.5%) found between the baseline values and values 12 months after the SLT was found to be statistically significant (p-value < 0.0001), as well as the average difference of 3.1 mm Hg (decrease by 14.9%) and 3.1 mm Hg (decrease by 14.9%) among the baseline IOP values and values found consequently after 24 and 36 months. Pigmentary glaucoma (35 eyes)--significant, but short-term effect of the SLT to the IOP decrease was observed. In two cases, shortly after the laser treatment, it was necessary due to extreme IOP elevation to perform the trabeculectomy. In 12 eyes it was necessary due to the unsatisfactory IOP compensation to repeat during one-year period the SLT procedure. Pseudoexfoliative glaucoma (37 eyes)--very good and rapidly appearing effect of the SLT to the IOP decrease was found. In 2 eyes, during the one-year follow-up period, it was performed the phacoemulsification of the lens with artificial intraocular lens (IOL) implantation. During further follow-up, the SLT was indicated and performed again in all eyes, and after that, in other 6 eyes of this group the phacoemulsification of the lens with IOL implantation was performed. The SLT as primary treatment (44 eyes)--all patients, even after 3 years follow-up period, are without the necessity of antiglaucomatous treatment. At the present time, the SLT was already performed in 122 eyes as the primary treatment. SLT as termination of the treatment (80 eyes)--in the remaining group of 40 patients, there are still 35 patients without treatment after three years, the data from the others are not available. Selective laser trabeculoplasty is effective and considerate method in the treatment of different groups of glaucoma diseases.
作者介绍了他们使用Laserex Tango激光机（波长532nm，调Q Nd:YAG激光，脉冲持续时间3纳秒，光斑直径400μm，80个烧灼点，前房角圆周扩展？，功率1.0mJ）对原发性开角型青光眼及其他青光眼组进行选择性激光小梁成形术改良后的结果。眼压通过根据现行法规校准的Nidek 2000非接触眼压计测量。第一组对75例年龄在21 - 80岁的患者的106只眼睛进行原发性开角型青光眼眼压变化随访，有7个对照，随访36个月。眼压从基线的20.7±4.6mmHg显著下降至17.5±3.1mmHg（1个月 - M1）、17.8±3.5mmHg（3个月 - M3）、17.7±3.1mmHg（6个月 - M6）、17.8±2.7mmHg（12个月 - M12）、17.9 + 2.6mmHg（24个月 - M24）和18.2 + 3.1mmHg（36个月 - M36）。治疗1个月后眼压从基线平均下降3.2mmHg（下降15.5%），差异有统计学意义（p值<0.0001），基线眼压值与3、6、12、24和36个月后相继测量的眼压值之间平均差异2.9mmHg（下降14.0%）、3.0mmHg（下降14.5%）、2.9mmHg（下降14.0%）、3.0mmHg（下降14.5%）、2.9mmHg（下降14.0%）、2.8mmHg（下降13.5%）和2.5mmHg（下降12.1%）也有统计学意义。第二组对263例年龄在21 - 84岁的患者的420只眼睛进行原发性开角型青光眼眼压及治疗变化随访，有3个对照，随访36个月。在三年随访期结束时，234只眼睛仍采用简化单一疗法，146只眼睛的治疗与激光手术前相同，40例需要再次进行选择性激光小梁成形术（SLT），其中19例因眼压补偿不满意而进行了小梁切除术。眼压从基线的20.8±4.1mmHg显著下降至18.0±2.8mmHg（12个月 - M12）、17.7±2.6mmHg（24个月 - M24）和17.7±3.1mmHg（36个月 - M36）。SLT后12个月基线值与眼压值之间平均眼压降低2.8mmHg（下降13.5%），差异有统计学意义（p值<0.0001），基线眼压值与24和36个月后眼压值之间平均差异3.1mmHg（下降14.9%）和3.1mmHg（下降14.9%）也有统计学意义。色素性青光眼（35只眼睛）——观察到SLT对眼压降低有显著但短期的效果。2例在激光治疗后不久因眼压极度升高而进行了小梁切除术。12只眼睛因眼压补偿不满意在一年内需要重复进行SLT手术。剥脱性青光眼（37只眼睛）——发现SLT对眼压降低有非常好且迅速出现的效果。2只眼睛在一年随访期内进行了晶状体超声乳化联合人工晶状体（IOL）植入术。在进一步随访中，该组所有眼睛均再次进行了SLT，之后，该组另外6只眼睛进行了晶状体超声乳化联合IOL植入术。SLT作为初始治疗（44只眼睛）——所有患者即使在三年随访期后也无需抗青光眼治疗。目前，已有122只眼睛进行了SLT作为初始治疗。SLT作为治疗终点（80只眼睛）——在其余40例患者组中，三年后仍有35例未接受治疗，其他患者的数据不可用。选择性激光小梁成形术是治疗不同类型青光眼疾病的有效且值得考虑的方法。
