Singh Kirti, Dangda Sonal, Ahir Nitasha, Mutreja Ankush, Bhattacharyya Mainak
Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.
, L-57, Sector-25, Noida, Uttar Pradesh, 201301, India.
Int Ophthalmol. 2017 Apr;37(2):365-370. doi: 10.1007/s10792-016-0270-z. Epub 2016 Jun 10.
High intraocular pressure (IOP) not responding to systemic and topical anti-glaucoma medications renders the eye at risk for both intra- and post-operative complications of glaucoma filtration surgery. Laser cyclophotocoagulation is able to lower IOP in such refractory glaucoma eyes and may make the surgical event safer. This study assessed diode laser cyclophotocoagulation (DLCP) when used as a temporary measure for lowering IOP prior to performing trabeculectomy. This study is a retrospective analysis of cases planned for trabeculectomy surgery, uncontrolled on maximally tolerable systemic anti-glaucoma medications. They were analysed for response to DLCP in terms of IOP control, vision-related complications, increased inflammation, post-trabeculectomy hypotony and chances of phthisis and ciliary shutdown. Twelve eyes of ten patients aged 35-65 years were identified and all followed up for at least 2 years. One week following DLCP, the IOP (mean ± SD) declined by 51 % from 46.8 ± 5.4 to 22.8 ± 3.3 mmHg. The IOP was further reduced to 15.4 ± 2.7 mmHg at 4 weeks after trabeculectomy; it remained in the mid-teens for a minimum of 2 years in all cases. The mean (±SD) visual acuity improved from 1.4 ± 0.4 to 0.8 ± 0.4 LogMAR equivalents following trabeculectomy. In four eyes, phacoemulsification was performed 5-7 months after trabeculectomy with improvement in best-corrected visual acuity. One patient developed transient hypotony, post-trabeculectomy, which resolved by 6 days. There were no other complications like increased inflammation, prolonged hypotony or suprachoroidal haemorrhage. DLCP is, thus, effective and safe for temporarily controlling IOP; thereby trabeculectomy can be performed in a quieter ocular milieu.
高眼压（IOP）对眼压）对全身和局部抗青光眼药物均无反应，使眼睛面临青光眼滤过手术术中及术后并发症的风险。激光睫状体光凝术能够降低此类难治性青光眼患者的眼压，并可能使手术更安全。本研究评估了二极管激光睫状体光凝术（DLCP）作为小梁切除术之前降低眼压的临时措施的效果。本研究是一项对计划进行小梁切除术的病例的回顾性分析，这些病例在最大耐受剂量的全身抗青光眼药物治疗下眼压仍未得到控制。分析了它们对DLCP的反应，包括眼压控制、视力相关并发症、炎症增加、小梁切除术后低眼压以及眼球痨和睫状体关闭的可能性。确定了10例年龄在35 - 65岁患者的12只眼，并对所有患者进行了至少2年的随访。DLCP术后1周，眼压（平均值±标准差）从46.8±5.4 mmHg下降了51%，降至22.8±3.3 mmHg。小梁切除术后4周，眼压进一步降至15.4±2.7 mmHg；在所有病例中，眼压在青少年中期水平维持至少2年。小梁切除术后，平均（±标准差）视力从1.4±0.4提高到0.8±0.4 LogMAR等效值。4只眼在小梁切除术后5 - 7个月进行了超声乳化白内障吸除术，最佳矫正视力有所改善。1例患者小梁切除术后出现短暂性低眼压，6天后缓解。未出现其他并发症，如炎症增加、持续性低眼压或脉络膜上腔出血。因此，DLCP对于临时控制眼压是有效且安全的；从而可以在更安静的眼内环境中进行小梁切除术。
