Ryabtseva A A, Khomyakova E N, Sergushev S G
Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russia.
Vestn Oftalmol. 2020;136(4):99-104. doi: 10.17116/oftalma202013604199.
The main objectives of glaucoma treatment are normalization of IOP and slowing of the progression of glaucomatous optic neuropathy. They are achieved using conservative (medicated), surgical and laser methods.
To study the effectiveness of non-penetrating hypotensive laser sclerotomy (NHLS) in patients with non-stabilized primary open-angle (I-III) b glaucoma with previous laser trabeculoplasty and who are receiving drug therapy.
The study included 54 patients (102 eyes) with initial (38 eyes), developed (46 eyes) and advanced (18 eyes) glaucoma who were examined and operated on. 26 patients (46 eyes) were instilled a combined drug containing brinzolamide and timolol, 28 patients (56 eyes) received prostaglandin F2α analogues (PGA). Intraocular pressure (IOP) levels were 27±2.4 mm Hg.
Reduction of IOP was observed in 89% of patients 2 weeks after NHLS with gradual improvement during the first 3 months of the follow-up; in 71% of patients the results preserved by the 6 month. Patients receiving combination of brinzolamide and timolol had more pronounced IOP reduction after NHLS amounting to 2.4±1.8 mm Hg in the first 3 months. By the end of the observation period IOP levels remained within normal range, drug therapy was ceased in 16 patients (21 eyes, 20.6%), 32 patients (67 eyes, 65.7%) achieved normalized intraocular pressure with antihypertensive therapy, and 9 patients (9 eyes, 8.8%) were referred to surgical treatment.
Non-penetrating hypotensive laser sclerotomy (NHLS) allows measured reduction of IOP in various glaucoma stages achieving controlled and persistent hypotensive effect. In the group of patients receiving combination of brinzolamide and timolol, the effect is statistically significant and clinically superior when compared with patients receiving PGA.
青光眼治疗的主要目标是使眼压正常化并减缓青光眼性视神经病变的进展。可通过保守（药物）、手术和激光方法实现这些目标。
研究非穿透性降压激光巩膜切开术（NHLS）对曾接受激光小梁成形术且正在接受药物治疗的非稳定性原发性开角（I - III）期青光眼患者的有效性。
该研究纳入了54例患者（102只眼），这些患者患有初期（38只眼）、进展期（46只眼）和晚期（18只眼）青光眼，并接受了检查和手术。26例患者（46只眼）滴注了含有布林佐胺和噻吗洛尔的复方药物，28例患者（56只眼）使用前列腺素F2α类似物（PGA）。眼压（IOP）水平为27±2.4 mmHg。
NHLS术后2周，89%的患者眼压降低，在随访的前3个月逐渐改善；6个月时，71%的患者眼压保持降低效果。接受布林佐胺和噻吗洛尔联合治疗的患者在NHLS术后眼压降低更明显，前3个月降低了2.4±1.8 mmHg。到观察期末，眼压水平保持在正常范围内，16例患者（21只眼，20.6%）停止药物治疗，32例患者（67只眼，65.7%）通过降压治疗使眼压正常化，9例患者（9只眼，8.8%）被转诊接受手术治疗。
非穿透性降压激光巩膜切开术（NHLS）可在青光眼的各个阶段适度降低眼压，实现可控且持久的降压效果。在接受布林佐胺和噻吗洛尔联合治疗的患者组中，与接受PGA治疗的患者相比，效果具有统计学显著性且在临床上更优。
