Kontić Marko, Ristić Dragana, Vukosavljević Miroslav
Srp Arh Celok Lek. 2014 Sep-Oct;142(9-10):524-8. doi: 10.2298/sarh1410524k.
Glaucoma is a chronic, progressive disease of the optic nerve which if left untreated can lead to blindness at end stages. A decrease of intraocular pressure (IOP) has proven to slow down the progression of the disease. IOP decrease can be achieved by medical, laser and surgical treatment.
The aim of this study was to evaluate the response of patients with medically uncontrolled primary open angle glaucoma to selective laser trabeculoplasty (SLT).
The study involved baseline characteristics recorded for each of 35 patients (48 eyes) in whom, despite being under full medication we could not achieve a satisfactory IOP. Patients, who had pressure above 25 mmHg under the maximal medication therapy, were not included into the study and were referred for surgical treatment. IOP was measured on admission, 1 hour, 7 days, 1, 3, 6 and 12 months after SLT. We considered satisfactory surgical result if IOP was decreased more than 20% of the initial value. Also, we investigated the influence of baseline IOP on SLT outcome after 12 months. Patient inclusion criteria were inability to reach target IOP with maximal medical therapy. Exclusion criteria were congenital glaucoma, any type of angle closure glaucoma, advanced-stage glaucoma, eyes with previous laser or surgical glaucoma applications and patients with baseline IOP > 25 while fully medicated. Patients who could not be followed for at least 12 months were also excluded.
The mean age of our patients was 73 ± 12 years. The mean baseline IOP was 20.48 mmHg (SD = 1.91), and the mean change in IOP from baseline of the treated eye after one year was 4.47 mmHg (SD = 2.12). In eyes with a higher baseline IOP the reduction of pressure at the end of the study was significantly higher. Satisfactory effect of IOP reduction after one year was achieved in 64.58% of eyes. The IOP reduction did not show to be dependent as regarding age and gender.
SLT effectively lowers IOP in patients with primary open-angle glaucoma, and the intervention is not followed by significant complications. Our results confirm that the IOP reduction is more significant if the initial value is higher. Our first reliable results of IOP reduction were confirmed one month after the procedure so that the procedure should not be repeated before one month has elapsed.The study is limited by a small number of eyes, which is insufficient to make a complete case analysis.
青光眼是一种慢性进行性视神经疾病，若不治疗，终末期可导致失明。降低眼压已被证明能减缓疾病进展。可通过药物、激光和手术治疗来降低眼压。
本研究旨在评估药物治疗无法控制的原发性开角型青光眼患者对选择性激光小梁成形术（SLT）的反应。
该研究记录了35例患者（48只眼）的基线特征，这些患者尽管接受了充分药物治疗，但眼压仍未达到满意水平。最大药物治疗下眼压高于25 mmHg的患者未纳入本研究，而是转至手术治疗。在入院时、SLT术后1小时、7天、1个月、3个月、6个月和12个月测量眼压。如果眼压降低超过初始值的20%，我们认为手术结果满意。此外，我们还研究了基线眼压对12个月后SLT结果的影响。患者纳入标准为最大药物治疗无法达到目标眼压。排除标准为先天性青光眼、任何类型的闭角型青光眼、晚期青光眼、既往有激光或手术青光眼治疗史的眼以及最大药物治疗下基线眼压>25 mmHg的患者。无法随访至少12个月的患者也被排除。
我们患者的平均年龄为73±12岁。平均基线眼压为20.48 mmHg（标准差=1.91），治疗眼眼压自基线起一年后的平均变化为4.47 mmHg（标准差=2.12）。基线眼压较高的眼中，研究结束时的眼压降低更为显著。一年后64.58%的眼眼压降低效果满意。眼压降低在年龄和性别方面未显示出依赖性。
SLT可有效降低原发性开角型青光眼患者的眼压，且该干预无明显并发症。我们的结果证实，初始眼压越高，眼压降低越显著。术后一个月证实了我们首次可靠的眼压降低结果，因此在一个月内不应重复该手术。本研究因眼数较少而受到限制，不足以进行完整的病例分析。
