Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Que..
Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Que.; Department of Ophthalmology, Queen's University, Kingston, Ont.
Can J Ophthalmol. 2021 Dec;56(6):371-378. doi: 10.1016/j.jcjo.2021.01.015. Epub 2021 Feb 10.
To evaluate the efficacy and safety of micropulse trans-scleral laser therapy (mTLT) in glaucomatous patients.
Prospective, interventional study in a university hospital setting.
Fifty-two eyes of 52 adult patients with uncontrolled glaucoma despite maximal tolerated medical treatment, and/or poor candidates for filtering surgery.
Participants received a 360-degree mTLT diode laser treatment (2000mW, 31.33% duty cycle), with duration adjusted to iris pigmentation and glaucoma severity (160-320 seconds). They were followed for 18 months to assess intraocular pressure (IOP), number of medications, corrected distance visual acuity (CDVA), glaucoma progression based on Humphrey Sita 24-2 perimetry and Cirrus high-definition optical coherence tomography, and complications. The primary outcome measure was the absolute success at 18 months. Absolute success was defined as an IOP 6-21 mm Hg and at least 25% IOP reduction, with equal or less number of IOP medications. Qualified success allowed for an increased number of IOP medications. Failure was defined as an inability to meet the criteria for success or the need for incisional glaucoma surgery.
Treatment absolute success was 61.5% at 12 months and 59.6% at 18 months. Mean IOP was reduced by 35.6% at 18 months (23.6 ± 6.5 mm Hg at baseline; 15.2 ± 4.1 mm Hg at 18 months, p < 0.001). mTLT did not significantly reduce the number of topical glaucoma medications (p = 0.075); however, 15 eyes (29%) had systemic oral glaucoma treatment at baseline and 10 eyes (20%) at 18 months. Eight patients (15%) experienced vision loss of ≥2 lines after the procedure. Three patients (6%) regained their preoperative CDVA by 1 month, and 3 patients (6%) by 3 months, while 2 patients (4%) sustained persistent visual loss. No ocular complications were noted in 84.6%. Incisional surgery was required in 25% of eyes owing to inadequately controlled glaucoma despite mTLT.
mTLT is a good therapeutic option for moderate IOP reduction, while being safe and predictable. This improved safety profile makes mTLT a treatment to be considered earlier in the management of glaucoma.
评估微脉冲经巩膜激光治疗（mTLT）在青光眼患者中的疗效和安全性。
在大学医院环境中进行的前瞻性、干预性研究。
52 名成年青光眼患者的 52 只眼，这些患者尽管接受了最大耐受的药物治疗，和/或不适合滤过性手术。
参与者接受了 360 度 mTLT 二极管激光治疗（2000mW，31.33%占空比），持续时间根据虹膜色素沉着和青光眼严重程度进行调整（160-320 秒）。对他们进行了 18 个月的随访，以评估眼压（IOP）、药物使用数量、矫正视力（CDVA）、基于 Humphrey Sita 24-2 视野计和 Cirrus 高清光学相干断层扫描的青光眼进展情况，以及并发症。主要观察指标为 18 个月时的绝对成功率。绝对成功定义为眼压 6-21mmHg，眼压降低至少 25%，同时使用的眼压药物数量相等或减少。合格的成功允许增加眼压药物的使用数量。失败定义为无法达到成功标准或需要进行切开性青光眼手术。
治疗 12 个月时的绝对成功率为 61.5%，18 个月时为 59.6%。18 个月时平均眼压降低了 35.6%（基线时 23.6±6.5mmHg，18 个月时 15.2±4.1mmHg，p<0.001）。mTLT 并没有显著减少局部降眼压药物的使用数量（p=0.075）；然而，15 只眼（29%）在基线时有全身口服降眼压药物，10 只眼（20%）在 18 个月时有全身口服降眼压药物。8 名患者（15%）在手术后视力下降≥2 行。3 名患者（6%）在 1 个月时恢复术前的 CDVA，3 名患者（6%）在 3 个月时恢复术前的 CDVA，而 2 名患者（4%）持续存在视力丧失。84.6%的患者没有观察到眼部并发症。尽管进行了 mTLT，但由于眼压控制不理想，仍有 25%的患者需要进行切开性手术。
mTLT 是一种降低眼压的良好治疗选择，同时安全且可预测。这种改善的安全性使 mTLT 成为青光眼治疗中更早考虑的治疗方法。
