Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, USA.
Br J Ophthalmol. 2023 Feb;107(2):221-226. doi: 10.1136/bjophthalmol-2021-318880. Epub 2021 Aug 30.
To explore the outcomes and mechanisms of intraocular pressure (IOP) control using low-dose transscleral cyclophotocoagulation (LDTSCP) followed by phacoemulsification in patients with prolonged acute primary angle closure (APAC).
Patients with prolonged APAC refractory to all other treatment modalities were prospectively recruited, and underwent LDTSCP (10 shots, 2 s duration, 120° treatment with the energy starting at 1500 mW and titrated to the level with audible burst but not exceeding 2000 mW) and anterior chamber paracentesis 1 week prior to phacoemulsification with intraocular lens implantation and viscogoniosynechiolysis. Postoperative IOP, vision, anatomic changes on anterior segment optical coherence tomography and complications were recorded.
Twenty eyes with prolonged APAC were recruited. Median follow-up was 12 months (range 9-18), at which point the vision in all eyes had improved and IOP was ≤17 mm Hg on no antiglaucoma medications. Following LDTSCP at postoperative day (POD) 1, IOP decreased in all eyes to a median 15 mm Hg (range: 6-28 mm Hg). Post-LDTSCP supraciliary effusion (SCE) occurred in 90% of eyes on POD1 or POD7 and ciliary body defect (CBD) was detected in 30% of eyes and resolved in all cases by postoperative month 1. Lower post-LDTSCP IOP was associated with more number of bursts (r=-0.558, p=0.011) and higher grade of SCE (r=-0.877, p<0.001), but not with total energy (p=0.240). Eyes with CBD (p=0.018) and a higher number of bursts (r=0.657, p=0.002) had higher grade SCE.
LDTSCP-induced SCE may explain the post-LDTSCP IOP reduction seen in eyes with prolonged APAC. LDTSCP instead of traditional more extensive treatment, was sufficient to provide a relatively safe and effective bridge therapy prior to phacoemulsification.
Chinese Clinical Trials Registry (ChiCTR1900023567).
探讨低剂量经巩膜睫状体光凝术（LDTSCP）联合白内障超声乳化吸除术治疗迁延性急性闭角型青光眼（APAC）的疗效和机制。
前瞻性招募迁延性 APAC 患者，对所有其他治疗方法均无反应，行 LDTSCP（10 次，每次 2 秒，120°治疗，起始能量 1500mW，可听到爆裂声但不超过 2000mW）和前房穿刺术，于白内障超声乳化吸除术、人工晶状体植入术和黏弹剂松解术前行 1 周。记录术后眼压、视力、眼前节光学相干断层扫描的解剖变化和并发症。
共纳入 20 例迁延性 APAC 患者。中位随访时间为 12 个月（范围 9-18 个月），所有患者视力均有所改善，且术后无需抗青光眼药物眼压≤17mmHg。术后第 1 天行 LDTSCP 后，所有患者眼压均降至中位数 15mmHg（范围：6-28mmHg）。术后第 1 天或第 7 天，90%的眼出现巩膜上腔积液（SCE），30%的眼出现睫状体缺损（CBD），所有病例在术后第 1 个月均得到缓解。术后 LDTSCP 眼压较低与爆裂次数较多（r=-0.558，p=0.011）和 SCE 程度较重（r=-0.877，p<0.001）相关，但与总能量无关（p=0.240）。有 CBD（p=0.018）和更多爆裂的眼（r=0.657，p=0.002）SCE 程度较重。
LDTSCP 诱导的 SCE 可能解释了迁延性 APAC 患者术后 LDTSCP 眼压降低的原因。LDTSCP 而非传统的更广泛治疗，在白内障超声乳化吸除术之前提供了一种相对安全有效的桥接治疗。
中国临床试验注册中心（ChiCTR1900023567）。
