Lee Jacky W Y, Wong Mandy O M, Liu Catherine C L, Lai Jimmy S M
*The Department of Ophthalmology, Caritas Medical Centre †The Department of Ophthalmology, The University of Hong Kong ‡The Department of Ophthalmology, Queen Mary Hospital §Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China.
J Glaucoma. 2015 Jun-Jul;24(5):e128-31. doi: 10.1097/IJG.0000000000000215.
To identify the optimal energy level to be used in selective laser trabeculoplasty (SLT) for maximal intraocular pressure (IOP) reduction in open-angle glaucoma (OAG) patients.
This cohort sequentially recruited OAG subjects in Hong Kong, China during 2011 to 2012. All subjects received a single session of SLT with near confluent spots to 360 degrees of the trabecular meshwork. An initial energy of 0.8 mJ was titrated until bubble formation was just visible. The main outcomes included: change in IOP (pre-SLT to 1 mo post-SLT) and total SLT energy (SLT spots multiplied by the mean energy). For statistical analysis, only the right eye of each subject was used. Bandwidth selection by generalized cross-validation was used to determine the optimal interval and point of total SLT energy that resulted in the largest IOP reduction.
A total of 49 Chinese OAG subjects had a mean age of 64.2±11.1 years. The pre-SLT IOP was 17.1±2.9 mm Hg while on 1.9±1.1 types of antiglaucoma eye drops. The mean total energy was 167.1±41.4 mJ (171.5±41.2 spots at 1.0±0.06 mJ). The 1 month post-SLT IOP was 13.5±2.8 mm Hg. The percentage of SLT success was 57.1% (28/49). The 95% confidence band by bootstrap method was plotted showing that a total energy between 214.6 and 234.9 mJ significantly decreased the IOP>25%, with the optimal total energy at 226.1 mJ.
A higher SLT energy, in the range of 214.6 to 234.9 mJ, seems to be associated with an improved IOP-lowering response. Further randomized control trials with treatment stratification are needed to confirm these results.
确定选择性激光小梁成形术（SLT）中用于降低开角型青光眼（OAG）患者眼压（IOP）的最佳能量水平。
该队列研究于2011年至2012年在中国香港连续招募OAG受试者。所有受试者均接受单次SLT治疗，小梁网360度范围的光斑几乎融合。初始能量为0.8 mJ，逐步滴定直至刚好可见气泡形成。主要观察指标包括：眼压变化（SLT术前至术后1个月）和总SLT能量（SLT光斑数乘以平均能量）。统计分析仅采用每位受试者的右眼数据。采用广义交叉验证法选择带宽，以确定导致眼压降低幅度最大的总SLT能量的最佳区间和点。
共有49例中国OAG受试者，平均年龄64.2±11.1岁。SLT术前眼压为17.1±2.9 mmHg，同时使用1.9±1.1种抗青光眼滴眼液。平均总能量为167.1±41.4 mJ（171.5±41.2个光斑，能量为1.0±0.06 mJ）。SLT术后1个月眼压为13.5±2.8 mmHg。SLT成功率为57.1%（28/49）。通过自举法绘制的95%置信带显示，总能量在214.6至234.9 mJ之间可使眼压显著降低>25%，最佳总能量为226.1 mJ。
214.6至234.9 mJ范围内的较高SLT能量似乎与更好的降眼压反应相关。需要进一步进行分层治疗的随机对照试验来证实这些结果。
