City Eye Centre, Brisbane, QLD, Australia.
Mayne Academy of Surgery, University of Queensland, Herston, QLD, Australia.
Clin Exp Ophthalmol. 2023 Mar;51(2):131-136. doi: 10.1111/ceo.14185. Epub 2022 Nov 9.
Trans-scleral diode laser cycloablation (cyclodiode) is effective in the short-term management of refractory glaucoma where alternative treatments are not feasible. Long-term outcomes of 5-years or more are not well-documented, particularly in relation to intraocular pressure (IOP) control, need for further procedures and complications such as hypotony and phthisis.
A review was undertaken of patient medical records with refractory glaucoma who underwent cyclodiode at City Eye Centre in Brisbane from 2012 to 2016. Data included sex, age, laterality, type of glaucoma, cyclodiode parameters, number of glaucoma medications, visual acuity and treatment with acetazolamide. Data were analysed using generalised linear modelling and Kaplan-Meier analysis.
A total of 54 eyes in 54 patients (29 M:25F) with a mean age of 66 years (range 15-85 years) with a minimum of 5 years follow up were included. The mean number of burns was 23.3 (range 12-40) over 180-270 degrees, mean power per burn was 1967 mW (range 1500-2000 mW), with a mean duration of 1981 ms (1500-2000 ms). The mean pre-treatment IOP was 31.5 mmHg (range 17-56 mmHg) and mean IOP 5 years post-treatment was 16.1 mmHg (2-42 mmHg). The mean number of pre-treatment medications was 3.6 (range 1-6) and 2.7 (range 0-5) 5 years post treatment, including 5 (8.3%) on oral acetazolamide. Complications of cyclodiode were seen in 6 (11.1%) patients, including 3 (5.0%) cases of hypotony, and 2 (3.3%) phthisis.
Cyclodiode is often utilised for end-stage glaucoma when the IOP is uncontrolled on medical treatment and drainage surgery is not indicated, resulting in long-term reduction of IOP and the number of medications, including acetazolamide. Hypotony and phthisis can be significant complications.
经巩膜二极管激光睫状体光凝术（cyclodiode）在治疗其他治疗方法不可行的难治性青光眼方面具有短期疗效。5 年或更长时间的长期结果记录不佳，特别是与眼压（IOP）控制、进一步治疗的需要以及低眼压和眼球萎缩等并发症有关。
对 2012 年至 2016 年在布里斯班市眼科中心接受 cyclodiode 治疗的难治性青光眼患者的病历进行了回顾。数据包括性别、年龄、侧别、青光眼类型、cyclodiode 参数、青光眼药物数量、视力和乙酰唑胺治疗。使用广义线性模型和 Kaplan-Meier 分析进行数据分析。
共纳入 54 例 54 只眼（29 例男性：25 例女性）患者，平均年龄 66 岁（15-85 岁），随访时间至少 5 年。平均烧伤次数为 23.3 次（12-40 次），烧伤角度为 180-270 度，平均每次烧伤功率为 1967mW（1500-2000mW），平均持续时间为 1981ms（1500-2000ms）。治疗前平均 IOP 为 31.5mmHg（17-56mmHg），治疗后 5 年平均 IOP 为 16.1mmHg（2-42mmHg）。治疗前平均用药数为 3.6 次（1-6 次），治疗后 5 年为 2.7 次（0-5 次），其中 5 例（8.3%）服用口服乙酰唑胺。6 例（11.1%）患者出现 cyclodiode 并发症，包括 3 例（5.0%）低眼压和 2 例（3.3%）眼球萎缩。
当药物治疗不能控制眼压且引流手术不适用时，cyclodiode 常被用于晚期青光眼，导致眼压和药物数量（包括乙酰唑胺）长期降低。低眼压和眼球萎缩是严重的并发症。
