Sheheitli Huda, Persad Patrice J, Feuer William J, Sayed Mohamed S, Lee Richard K
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Glaucoma. 2021 Sep-Oct;4(5):472-481. doi: 10.1016/j.ogla.2020.12.014. Epub 2021 Jan 8.
To report treatment outcomes of primary transscleral cyclophotocoagulation (TSCPC) in glaucomatous eyes.
Retrospective noncomparative study.
Forty-eight eyes with a diagnosis of glaucoma and no previous incisional ocular surgery.
Continuous-wave TSCPC was applied to the ciliary body.
The primary outcome measure was surgical success defined as an IOP ≤ 21 mmHg and reduced by 20% or more from baseline, IOP > 5 mmHg, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures included visual acuity (VA) and complications.
Glaucoma eyes were stratified into 2 groups: (1) those with pretreatment IOP >21 mmHg (high group) and (2) those with pretreatment IOP ≤ 21 mmHg (low group). Mean ± standard deviation (SD) IOP at baseline was 30.6 ± 6.3 mmHg in the high group and 16.2 ± 2.8 mmHg in the low group. Mean ± SD number of glaucoma medications at baseline was 4.1 ± 0.8 in the high group and 3.6 ± 1.1 in the low group. Based on our success criteria, the cumulative probability of success during the first year of follow-up was 58.3% in the high group and 28.1% in the low group (P = 0.052). Postoperative mean IOP was significantly lower than baseline IOP in the high group at 1-, 3-, 6-, 12-, and 18-month postoperative visits (P < 0.05). No significant change was observed in IOP at follow-up visits after 1 month in the low IOP group. Throughout the first year of follow-up, both groups required fewer glaucoma medications compared with baseline at the 1-, 3-, 6-, and 12-month postoperative visits (P < 0.05). The most frequent cause of postoperative decrease in VA was cataract in 9 eyes. Decrease in vision resulting from glaucoma was observed in 3 eyes. Complications included prolonged inflammation (11 eyes), iris neovascularization (2 eyes), cystoid macular edema (4 eyes), and hyphema (1 eye). No severe or long-term complications were observed.
Continuous-wave TSCPC was effective in lowering IOP in glaucoma patients without prior incisional ocular surgery whose disease was recalcitrant to medical therapy, particularly those with baseline IOP of more than 21 mmHg.
报告青光眼患者原发性经巩膜睫状体光凝术（TSCPC）的治疗结果。
回顾性非对照研究。
48只诊断为青光眼且既往未行眼部切开手术的眼睛。
对睫状体进行连续波TSCPC治疗。
主要观察指标为手术成功，定义为眼压≤21 mmHg，较基线降低20%或更多，眼压>5 mmHg，无需因青光眼再次手术，且无光感丧失。次要观察指标包括视力（VA）和并发症。
青光眼患者分为两组：（1）治疗前眼压>21 mmHg的患者（高眼压组）和（2）治疗前眼压≤21 mmHg的患者（低眼压组）。高眼压组基线时平均±标准差（SD）眼压为30.6±6.3 mmHg，低眼压组为16.2±2.8 mmHg。高眼压组基线时平均±SD青光眼药物使用数量为4.1±0.8，低眼压组为3.6±1.1。根据我们的成功标准，随访第一年的累积成功概率在高眼压组为58.3%，在低眼压组为28.1%（P = 0.052）。高眼压组术后1、3、6、12和18个月随访时的平均眼压显著低于基线眼压（P < 0.05）。低眼压组在1个月后的随访中眼压无显著变化。在随访的第一年中，两组在术后1、3、6和12个月时与基线相比所需的青光眼药物均减少（P < 0.05）。术后视力下降最常见的原因是白内障，共9只眼。3只眼出现因青光眼导致的视力下降。并发症包括炎症持续时间延长（11只眼）、虹膜新生血管形成（2只眼）、黄斑囊样水肿（4只眼）和前房积血（1只眼）。未观察到严重或长期并发症。
连续波TSCPC对于药物治疗无效且既往未行眼部切开手术的青光眼患者降低眼压有效，尤其是基线眼压高于21 mmHg的患者。
