Glaucoma Center-Morocco, résidence Oisis, boulevard Mohammed V, Mohammedia, Morocco.
Glaucoma Center-Morocco, résidence Oisis, boulevard Mohammed V, Mohammedia, Morocco.
J Fr Ophtalmol. 2022 Jan;45(1):93-103. doi: 10.1016/j.jfo.2021.06.006. Epub 2021 Nov 23.
The goal of our study was to compare the outcomes of transscleral diode cyclophotocoagulation using a new protocol with new settings. In fact, we targeted the ciliary body guided by transillumination, reduced the energy applied at each spot, and enlarged the treatment area posteriorly from the pars plicata to the pars plana.
Data were collected retrospectively from two groups of glaucoma patients. The first group of patients underwent transscleral diode laser cyclophotocoagulation as usual, with one-row applications of a maximum of 1200mW of energy and a duration of 2000ms. The second group was treated in three rows, using the same settings as the first group. Transillumination was used continuously during all of our procedures, to focus accurately on the location of the ciliary body. Outcome measures included intraocular pressure (IOP) and visual acuity (VA) at baseline and at a minimum of 3 months postoperatively, as well as complications occurring up until last follow-up visit. Patients were considered successfully treated if their intraocular pressure was lowered by at least 25% compared to their baseline or if their intraocular pressure was less than 21mmHg after the procedure, with or without glaucoma medications.
Sixty eyes were treated with the one-row protocol, followed by 508 eyes treated with the three-row protocol. The mean follow-up was 19 (range 3-31) months. Success rates were 62% and 86% for the one-row group and three-row group, respectively. The IOP decrease was 40.5% (a mean reduction from 37.5±8.1mmHg to 22.3±10.2mmHg) in the one-row group and 57.6% in the three-row group (mean reduction from 36.05±10.4mmHg to 15.7±7.3mmHg), which was statistically significant in each group (P=0.0001). Additionally, a significant improvement in efficacy was found in the 3-row compared to the 1-row group (P=0.0001) No significant difference was found in VA before or after the procedure or between the 2 groups. No serious complications were reported.
Diode laser TSCPC is a practical, rapid and well-tolerated procedure. The treatment protocol used, with lower energy levels applied to the eye, guided systematically by transillumination and targeting a wider area, appears to be safer and more effective.
我们研究的目的是比较使用新方案和新参数的经巩膜二极管光凝术的结果。事实上，我们通过透照引导睫状体，降低每个光斑的能量，并将治疗区域从睫状体扁平部向后扩展到睫状体平坦部。
数据从两组青光眼患者中回顾性收集。第一组患者接受经巩膜二极管激光睫状体光凝术，采用一行最大能量 1200mW，持续时间 2000ms。第二组采用与第一组相同的参数，分三行治疗。我们的所有操作过程中均连续进行透照，以准确聚焦睫状体的位置。疗效评估包括术前和术后至少 3 个月的眼压（IOP）和视力（VA），以及直到最后一次随访时出现的并发症。如果患者的眼压与基线相比降低至少 25%，或者术后眼压低于 21mmHg，无论是否使用青光眼药物，均认为治疗成功。
60 只眼采用一行方案治疗，508 只眼采用三行方案治疗。平均随访时间为 19 个月（范围 3-31 个月）。一行组的成功率为 62%，三行组为 86%。一行组眼压下降 40.5%（平均从 37.5±8.1mmHg 降至 22.3±10.2mmHg），三行组下降 57.6%（平均从 36.05±10.4mmHg 降至 15.7±7.3mmHg），两组间差异均有统计学意义（P=0.0001）。此外，三行组的疗效明显优于一行组（P=0.0001）。术前和术后 VA 或两组间 VA 无显著差异。未报告严重并发症。
二极管激光 TSCPC 是一种实用、快速、耐受良好的方法。我们使用的治疗方案，能量水平较低，通过透照系统引导，治疗区域较宽，似乎更安全、更有效。
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