Baranov I Ya, Shiryaev I V, Molodkina N A, Efimov O A, Mitrofanova N V
Saint Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution, 21 Yaroslava Gasheka St., Saint Petersburg, Russian Federation, 192283.
North-Western State Medical University named after I.I. Mechnikov, Education-clinical complex #1, 1/82 Zanevsky Pr., Saint Petersburg, Russian Federation, 195196.
Vestn Oftalmol. 2018;134(5):26-31. doi: 10.17116/oftalma201813405126.
To evaluate the influence of different topical hypotensive drugs on incidence of choroidal effusion (CE) following laser trabeculoplasty as the second stage of combined laser-surgical treatment plan in patients with primary open-angle glaucoma (POAG).
The study included 60 patients with previously operated stage I and II POAG who has 'b-c' intraocular pressure (IOP) on maximum hypotensive therapy. Fistulizing subscleral removal of the outer wall of Schlemm's canal (a.k.a. subscleral sinusotomy) was the first stage of treatment plan. The second stage took place 14 days later in the form of laser trabeculoplasty. In order to reduce the risk of IOP spikes, all patients were prescribed specific hypotensive therapy 5 days prior to the procedure. The 1 group included 30 patients (30 eyes) who were asked to use Brimonidine-Purite (0.15%). The 2 group included 30 patients (30 eyes) who used either nonselective β-blockers, or carbonic anhydrase inhibitors. IOP was measured on days 1, 5, 9, and 12 after stage 1, as well as after laser trabeculoplasty. Ophthalmic examination included ultrasound imaging and optical coherence tomography.
After the combined laser-surgical treatment, the IOP reliably decreased in both groups. Choroidal effusion was observed in 7 cases in the 1 group and in 15 cases in the 2 group. Change in IOP was less prominent in patients who had received instillations of α-adrenomimetic (p<0.05).
Patients who received Brimonidine-Purite 0.15% before laser trabeculoplasty had lower IOP drop than those on pre-surgical therapy with nonselective β-blockers or carbonic anhydrase inhibitors. Topical application of 0.15% Brimonidine-Purite 5 days prior to laser trabeculoplasty as the second stage of combined laser-surgical treatment resulted in statistically significant reduction of the incidence of postoperative choroidal effusion, likely due to α-adrenomimetics inhibiting the secretory function of the ciliary Body to the lesser extent than drugs of other groups that were tested.
评估在原发性开角型青光眼（POAG）患者联合激光手术治疗方案的第二阶段——激光小梁成形术后，不同局部降压药物对脉络膜积液（CE）发生率的影响。
该研究纳入60例曾接受过I期和II期POAG手术、在最大降压治疗下眼压为“b - c”的患者。Schlemm管外壁造瘘性巩膜下切除术（即巩膜下窦切开术）为治疗方案的第一阶段。第二阶段在14天后以激光小梁成形术的形式进行。为降低眼压峰值风险，所有患者在手术前5天接受特定的降压治疗。第1组包括30例患者（30只眼），他们被要求使用酒石酸溴莫尼定（0.15%）。第2组包括30例患者（30只眼），他们使用非选择性β受体阻滞剂或碳酸酐酶抑制剂。在第一阶段后的第1、5、9和12天以及激光小梁成形术后测量眼压。眼科检查包括超声成像和光学相干断层扫描。
联合激光手术后，两组眼压均可靠下降。第1组有7例出现脉络膜积液，第2组有15例。接受α - 肾上腺素能激动剂滴眼的患者眼压变化不太明显（p<0.05）。
在激光小梁成形术前接受0.15%酒石酸溴莫尼定的患者眼压下降幅度低于术前使用非选择性β受体阻滞剂或碳酸酐酶抑制剂治疗的患者。作为联合激光手术治疗的第二阶段，在激光小梁成形术前5天局部应用0.15%酒石酸溴莫尼定可使术后脉络膜积液发生率在统计学上显著降低，这可能是因为α - 肾上腺素能激动剂对睫状体分泌功能的抑制程度低于所测试的其他组药物。
