经巩膜二极管激光睫状体光凝术：缓慢凝固与标准凝固技术的比较。
Transscleral Diode Laser Cyclophotocoagulation: A Comparison of Slow Coagulation and Standard Coagulation Techniques.
机构信息
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
出版信息
Ophthalmol Glaucoma. 2018 Sep-Oct;1(2):115-122. doi: 10.1016/j.ogla.2018.08.007. Epub 2018 Aug 25.
PURPOSE
To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma.
DESIGN
Retrospective case series.
SUBJECTS
This study included 78 eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course.
METHODS
This study compared 52 eyes treated with slow coagulation TSCPC to 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings and outcomes were assessed.
MAIN OUTCOME MEASURES
The main outcome measures were visual acuity (VA), intraocular pressure (IOP) and post-surgical complications.
RESULTS
The initial LogMAR VA was 1.94 (0.73) [mean (SD)] in the slow coagulation TSCPC group and 1.71 (0.90) in the standard TSCPC group (p=0.507). Initial IOP was 37 (13) mm Hg in the slow coagulation group and 39 (13) mm Hg in the standard group (p=0.297). The follow-up periods were 16.36 months and 24.68 months for the slow coagulation and standard groups (p=0.124). VA remained better than light-perception in 71.1% of slow coagulation treated patients and 65.0% of standard TSCPC treated patients (p=0.599). IOP remained below 20 mm Hg in 46% of slow coagulation treated patients and 44% of standard TSCPC treated patients (p=0.870). The mean number of complications was higher in the standard group [1.46 (1.24)] versus the slow coagulation group [0.62 (0.75)] (p=0.002). The incidence of the need for a second procedure (slow coagulation- 28.8%, standard- 23.1%, p=0.588) and maximum number of medications needed to control IOP postoperatively (p=0.771) were similar between the two groups.
CONCLUSIONS
In this case series, slow coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques were also comparable, although standard TSCPC had a higher incidence of prolonged inflammation postoperatively. This study suggests that slow coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged post-operative inflammation-a feared complication of TSCPC-when compared to standard "pop-titrated" TSCPC.
目的
比较标准弹丸式经巩膜睫状体光凝（TSCPC）和慢凝 TSCPC 治疗青光眼的效果。
设计
回顾性病例系列。
研究对象
本研究纳入了 78 只患有任何类型或阶段青光眼的眼睛，这些眼睛在治疗过程中接受了 TSCPC 治疗。
方法
本研究比较了 52 只接受慢凝 TSCPC 治疗的眼睛和 26 只接受标准弹丸式 TSCPC 治疗的眼睛。评估了患者的人口统计学资料、治疗过程、手术技术、设置和结果。
主要观察指标
主要观察指标为视力（VA）、眼压（IOP）和术后并发症。
结果
慢凝 TSCPC 组的初始 LogMAR VA 为 1.94（0.73）[平均值（标准差）]，标准 TSCPC 组为 1.71（0.90）（p=0.507）。慢凝 TSCPC 组的初始 IOP 为 37（13）mmHg，标准 TSCPC 组为 39（13）mmHg（p=0.297）。慢凝 TSCPC 组和标准 TSCPC 组的随访时间分别为 16.36 个月和 24.68 个月（p=0.124）。在接受慢凝治疗的患者中，71.1%的患者 VA 仍优于光感，而接受标准 TSCPC 治疗的患者中，65.0%的患者 VA 仍优于光感（p=0.599）。在接受慢凝治疗的患者中，46%的患者 IOP 仍低于 20mmHg，而接受标准 TSCPC 治疗的患者中，44%的患者 IOP 仍低于 20mmHg（p=0.870）。标准组的平均并发症数[1.46（1.24）]高于慢凝组[0.62（0.75）]（p=0.002）。两组中需要二次手术的发生率（慢凝组 28.8%，标准组 23.1%，p=0.588）和术后控制 IOP 所需的最大药物数量（p=0.771）相似。
结论
在本病例系列研究中，慢凝 TSCPC 和标准弹丸式 TSCPC 在治疗青光眼眼中均获得了相似的 VA 和 IOP 结果。这两种技术的并发症谱也相似，尽管标准 TSCPC 术后炎症持续时间较长。本研究表明，与标准“弹丸式”TSCPC 相比，慢凝 TSCPC 可能在眼压控制方面效果相当，同时降低了术后炎症持续时间较长这一 TSCPC 可怕的并发症发生率。
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