Glaucoma Center of San Francisco.
Glaucoma Research and Education Group.
J Glaucoma. 2020 Dec;29(12):1126-1131. doi: 10.1097/IJG.0000000000001644.
PRéCIS:: Micropulse cyclophotocoagulation (MPCP) lowered intraocular pressure (IOP) in the short-term but nearly half required additional intervention. Mydriasis was the most common complication (11%); 15% lost ≥3 Snellen lines of acuity; 11% had persistent complications at last follow-up.
The purpose of this study was to evaluate the efficacy and complications of MPCP in a large series of patients with all stages of glaucoma.
Multicenter, retrospective chart review of patients from 3 clinical sites.
One hundred sixty-seven eyes of 143 patients.
MPCP was performed with 2000 mW energy, 31.3% duty cycle and 2 to 4 180-degree applications of 80 seconds duration each per treatment. The procedure was considered a failure if any of the following occurred: additional IOP lowering intervention, <20% IOP reduction from baseline at the last follow-up (with or without medication), or severe complications.
Mean age was 71 years, 53% were female, and 53% were Asian. 60% of eyes had POAG, 63% were pseudophakic, 38% had prior glaucoma surgery, and 51% had Snellen visual acuity (VA) of 20/40 or better. Mean follow-up time was 11.9±7.8 months. Mean IOP was 21.9±8.4 mm Hg before intervention, and 17.4±7.2 mm Hg at last follow-up (P<0.0001). There was no change in mean logMAR VA (P=0.0565) but 15% lost ≥3 Snellen lines of VA. The success rate was 36.5% (61/167 eyes) at last follow-up. The probability of survival by Kaplan-Meier analysis was 82%, 71%, and 57% at 3, 6, and 12 months after the procedure, respectively. The reasons for failure were additional intervention in 47%, inadequate IOP reduction in 14%, and severe complication in 1.8%. In a multivariable Cox proportional hazard model, female sex was associated with a 56% decrease in failure rate compared with males (P<0.0001), while a unit increase in baseline IOP corresponded with a 5.7% increase in failure rate (P<0.0001). If repeat MPCP was allowed then success rate increased to 58%. There were no complications in 73% (122/167) but 11% (18/167) had persistent complications at the last follow-up and half of these 18 eyes had decrease in VA of 1 to 6 Snellen lines. Asian race (odds ratio 13.5, P=0.0131) and phakic status (odds ratio 3.1, P=0.0386) were associated with higher odds of developing mydriasis, which was the most common complication.
MPCP lowered IOP in the short-term but nearly half required additional IOP lowering intervention. Potential complications should be discussed in detail especially when the procedure is being considered for those with good VA and early stage disease.
要点摘要：微脉冲睫状体光凝术（MPCP）在短期内降低了眼内压（IOP），但近一半的患者需要额外的干预。散瞳是最常见的并发症（11%）；15%的患者视力丧失≥3 行 Snellen 视力表；11%的患者在最后一次随访时仍存在持续的并发症。
本研究旨在评估 MPCP 在各种阶段青光眼患者中的疗效和并发症。
对来自 3 个临床地点的患者进行多中心、回顾性图表分析。
143 例患者的 167 只眼。
采用 2000mW 能量、31.3%占空比和 2 至 4 个 180 度应用，每个治疗持续 80 秒。如果发生以下任何一种情况，手术被认为是失败的：需要进行额外的眼压降低干预、最后一次随访时眼压较基线水平降低<20%（无论是否使用药物），或发生严重并发症。
平均年龄为 71 岁，53%为女性，53%为亚洲人。60%的眼睛患有原发性开角型青光眼，63%为人工晶状体眼，38%有既往青光眼手术史，51%有 20/40 或更好的 Snellen 视力。平均随访时间为 11.9±7.8 个月。干预前平均 IOP 为 21.9±8.4mmHg，最后一次随访时为 17.4±7.2mmHg（P<0.0001）。平均对数视力（logMAR）VA 无变化（P=0.0565），但 15%的患者视力丧失≥3 行 Snellen 视力表。最后一次随访时的成功率为 36.5%（61/167 只眼）。Kaplan-Meier 分析显示，术后 3、6 和 12 个月时的生存率分别为 82%、71%和 57%。失败的原因是：47%的患者需要额外的干预，14%的患者眼压降低不足，1.8%的患者出现严重并发症。在多变量 Cox 比例风险模型中，与男性相比，女性的失败率降低了 56%（P<0.0001），而基线 IOP 每增加 1mmHg，失败率增加 5.7%（P<0.0001）。如果允许重复 MPCP，则成功率增加至 58%。在 167 只眼中，73%（122 只）没有并发症，但在最后一次随访时有 11%（18 只）仍存在持续的并发症，其中一半的患者视力下降了 1 至 6 行 Snellen 视力表。亚洲种族（优势比 13.5，P=0.0131）和有晶状体眼状态（优势比 3.1，P=0.0386）与散瞳的发生率较高相关，散瞳是最常见的并发症。
MPCP 在短期内降低了 IOP，但近一半的患者需要额外的眼压降低干预。在考虑对视力良好和早期疾病患者进行该手术时，应详细讨论潜在的并发症。
