Jammal Alessandro Adad, Costa Danilo Campos, Vasconcellos José Paulo Cabral, Costa Vital Paulino
Department of Ophthalmology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
Arq Bras Oftalmol. 2019 Jun 27;82(5):381-388. doi: 10.5935/0004-2749.20190076.
To evaluate the effectiveness in in-traocular pressure reduction and safety of micropulse trans-scleral diode cyclophotocoagulation in refractory glaucoma.
We prospectively evaluated a case series of 21 eyes of 21 consecutive patients with refractory glaucoma treated with micropulse transscleral diode cyclophotocoagulation at 12-month follow-up. The total treatment time was at the discretion of the surgeon, considering baseline and target intraocular pressure and glaucoma diagnosis. Intraocular pressure, inflammation, visual acuity, and number of medications were monitored. Success was defined as intraocular pressure between 6 and 21 mmHg and/or 30% reduction from baseline intraocular pressure with or without the use of antiglaucoma medications. Visual acuity loss was defined as a loss of ≥2 lines of vision on the Snellen chart or a ≥2-level decrease in visual function in patients with nonmeasurable chart acuity.
The mean age was 61.04 ± 12.99 years, and 11 (52.4%) patients were male, with most (95%) patients showing low visual acuity at baseline (count fingers or worse). The mean intraocular pressure was 33.38 ± 15.95 mmHg, and the mean number of medications was 3.5 ± 1.1 at baseline. After 1, 3, 6, and 12 months, 76.19%, 57.14%, 55.56%, and 66.67%, respectively, of the patients were classified as treatment successes. Seven (33.3%) patients required new laser treatment and were considered treatment failures. The mean intraocular pressure reduction was 44.72% ± 29.72% in the first week and 41.59% ± 18.93% at the end of follow-up (p=0.006). The mean number of medications significantly dropped to 2.00 ± 1.7 at the 12-month visit (p=0.044). Complications included hypotony (4.8%), intraocular inflammation after 1 month (19%), and visual acuity loss (4.8%).
Micropulse transscleral diode cyclophotocoagulation was safe and effective for reducing intraocular pressure in eyes with refractory and advanced glaucoma, with reduced need for ocular antihypertensive medication.
评估微脉冲经巩膜二极管睫状体光凝术治疗难治性青光眼降低眼压的有效性及安全性。
我们前瞻性评估了连续21例难治性青光眼患者的21只眼，采用微脉冲经巩膜二极管睫状体光凝术治疗并随访12个月。总治疗时间由手术医生根据基线眼压、目标眼压及青光眼诊断情况自行决定。监测眼压、炎症反应、视力及用药数量。成功定义为眼压在6至21 mmHg之间和/或与基线眼压相比降低30%，无论是否使用抗青光眼药物。视力下降定义为在Snellen视力表上视力下降≥2行，或对于视力表无法测量的患者，视觉功能下降≥2级。
平均年龄为61.04±12.99岁，11例（52.4%）患者为男性，大多数（95%）患者基线视力较低（指数或更差）。基线时平均眼压为33.38±15.95 mmHg，平均用药数量为3.5±1.1种。在1、3、6和12个月时，分别有76.19%、57.14%、55.56%和66.67%的患者被归类为治疗成功。7例（33.3%）患者需要再次进行激光治疗，被视为治疗失败。第一周平均眼压降低44.72%±29.72%，随访结束时为41.59%±18.93%（p = 0.006）。在12个月的随访中，平均用药数量显著降至2.00±1.7种（p = 0.044）。并发症包括低眼压（4.8%）、1个月后眼内炎症（19%）和视力下降（4.8%）。
微脉冲经巩膜二极管睫状体光凝术对于难治性晚期青光眼患者降低眼压是安全有效的，且减少了眼部抗高血压药物的使用需求。
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