比较难治性开角型青光眼患者微脉冲经巩膜睫状体光凝术和“慢烤”二极管激光经巩膜睫状体光凝术的安全性和有效性。
Comparison of safety and effectiveness of micropulse transscleral cyclophotocoagulation and "slow cook" diode laser transscleral cyclophotocoagulation in patients with refractory open-angle glaucoma.
机构信息
HR Oftalmologia, Curitiba, PR, Brazil.
HCLOE Clínica de Oftalmologia Especializada, São Paulo, SP, Brazil.
出版信息
Arq Bras Oftalmol. 2024 Aug 2;88(1):e20230103. doi: 10.5935/0004-2749.2023-0103. eCollection 2024.
PURPOSE
This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and "slow cook" transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma.
METHODS
We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B).
RESULTS
We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was -0.10 ± 0.35 and -0.074 ± 0.16 in the micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the "slow cook" and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the "slow cook" transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p<0.001).
CONCLUSION
Both techniques reduced intraocular pressure effectively.
目的
本研究旨在比较微脉冲经巩膜睫状体光凝术和“慢烤”经巩膜睫状体光凝术在难治性原发性开角型青光眼患者中降低眼压的安全性和有效性。
方法
我们纳入了至少随访 12 个月的原发性开角型青光眼患者。我们收集并分析了术前特征和术后结果的数据。主要结局是基线值降低≥20%（标准 A）和/或眼压在 6 至 21mmHg 之间（标准 B）。
结果
我们纳入了 128 只原发性开角型青光眼眼。微脉冲组和“慢烤”经巩膜睫状体光凝组术前平均眼压分别为 25.53±6.40mmHg 和 35.02±12.57mmHg（p<0.001）。微脉冲组和“慢烤”经巩膜睫状体光凝组在最后一次随访时的平均眼压分别显著降低至 14.33±3.40mmHg 和 15.37±5.85mmHg（p=0.110）。微脉冲组和“慢烤”经巩膜睫状体光凝组在 12 个月时的平均眼压降低分别为 11.20±11.46mmHg 和 19.65±13.22mmHg（p<0.001）。微脉冲组和“慢烤”经巩膜睫状体光凝组术前平均 logMAR 视力分别为 0.52±0.69 和 1.75±1.04（p<0.001）。微脉冲组和“慢烤”经巩膜睫状体光凝组的平均视力变化分别为-0.10±0.35 和-0.074±0.16（p=0.510）。术前，微脉冲组和“慢烤”经巩膜睫状体光凝组的平均滴眼药物分别为 3.44±1.38 种和 2.89±0.68 种（p=0.017），但在“慢烤”和微脉冲经巩膜睫状体光凝组结束时，分别为 2.06±1.42 种和 1.02±1.46 种（p<0.001）。两组之间标准 A 的成功率没有显著差异。与“慢烤”经巩膜睫状体光凝组的 11 只眼（17.74%）相比，微脉冲经巩膜睫状体光凝组的 19 只眼（28.78%）显示完全成功（p=0.171）。对于标准 B，微脉冲组和“慢烤”经巩膜睫状体光凝组分别有 28 只（42.42%）和 2 只眼（3.22%）完全成功（p<0.001）。
结论
两种技术均能有效降低眼压。
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