Department of Ophthalmology, University of Szeged, Szeged, Hungary.
Department of Ophthalmology, Péterfy Hospital, Budapest, Hungary.
BMC Ophthalmol. 2024 Jun 3;24(1):233. doi: 10.1186/s12886-024-03505-7.
The long-term safety and efficacy of repeated applications of subliminal transscleral cyclophotocoagulation (SL-TSCPC) with a focus on cumulative energy was evaluated in glaucoma patients.
In this retrospective, multicentric study the data of a total of 82 eyes with various causes of glaucoma that were treated with a single or multiple applications of SL-TSCPC were collected. Treatments were performed under general or local anesthesia with an 810 nm diode laser. Power was 2000 mW; duty cycle, 31.3%; total treatment duration, 80-320 s; equaling a total energy of 50-200 J per treatment session. Fifty-five eyes (55 patients) presented for all follow-ups, and these eyes were selected for further statistical analysis. The mean age was 60.0 ± 17.1 years, and 22 (40%) of the patients were female. Intraocular pressure (IOP) and dependence on further glaucoma medication were evaluated at 12 months following the initial treatment.
Eyes underwent 1 or 2 consecutive SL-TSCPC treatments. Median (min-max) baseline IOP of 34 (13-69) decreased to 21.5 (7-61), 22 (8-68), 20 (9-68), and 19.5 (3-60) mmHg at the 1, 3, 6, and 12-month postoperative timepoints respectively. The mean (± SD) IOP decrease at 12 months was 26 ± 27%, 39 ± 32%, and 49 ± 33% in the low (below 120 J, n = 18), medium (120-200 J, n = 24), and high (above 200 J, n = 13) cumulative energy groups respectively. At the 12-month timepoint, oral carbonic anhydrase use was discontinued in ¾ of the cases.
It was found that the repeated application of SL-TSCPC safely and efficiently decreases IOP in a Caucasian population with heterogenous causes of glaucoma, eyes with silicone oil responded to a greater extent. Inclusion of cumulative energy scales may contribute to better addressing repeated procedures in a standardized fashion.
本研究旨在评估重复进行阈下经巩膜睫状体光凝术（SL-TSCPC）治疗对青光眼患者的长期安全性和疗效，重点关注累积能量。
本回顾性多中心研究共纳入了 82 只眼，这些眼患有各种类型的青光眼，接受了单次或多次 SL-TSCPC 治疗。治疗采用 810nm 半导体激光，在全身或局部麻醉下进行。功率为 2000mW，占空比为 31.3%，治疗总时长为 80-320s，每次治疗的总能量为 50-200J。共有 55 只眼（55 例患者）完成了所有随访，这些眼被选择用于进一步的统计分析。平均年龄为 60.0±17.1 岁，22 例（40%）患者为女性。在初次治疗后 12 个月时评估眼压（IOP）和对进一步青光眼药物治疗的依赖情况。
眼接受了 1 次或 2 次连续的 SL-TSCPC 治疗。中位（最小-最大）基线 IOP 为 34（13-69）mmHg，分别在术后 1、3、6 和 12 个月时降至 21.5（7-61）、22（8-68）、20（9-68）和 19.5（3-60）mmHg。在 12 个月时，低（累积能量<120J，n=18）、中（累积能量 120-200J，n=24）和高（累积能量>200J，n=13）组的平均 IOP 下降率分别为 26±27%、39±32%和 49±33%。在 12 个月时，75%的病例停止了口服碳酸酐酶抑制剂治疗。
在患有不同病因的白种人青光眼患者中，重复进行 SL-TSCPC 治疗安全且有效地降低了眼压，硅油眼的反应更为明显。累积能量的纳入可能有助于以标准化的方式更好地处理重复治疗。
