Aier Eye Hospital, Jinan University, Guangzhou, Guangdong Province, 510071, China.
Aier Glaucoma Institute, Changsha, Hunan Province, China.
BMC Ophthalmol. 2024 Aug 26;24(1):371. doi: 10.1186/s12886-024-03628-x.
The present study elucidates a common significant postoperative complication of micropulse transscleral laser treatment (mTLT) and explores its potential management strategies for younger patients with good central vision.
Three younger Chinese glaucoma patients with good central vision maintained high intraocular pressures (IOPs) (36, 25, and 30 mmHg) on maximally tolerated topical anti-glaucoma medications. All patients were treated with mTLT because of a higher risk of complications with filtering surgery. After the procedure, their best-corrected visual acuities were not significantly changed, IOPs were significantly decreased, and the number of topical anti-glaucoma medicines was gradually decreased. However, all patients complained about reduced near visual acuity (NVA) for 1-5 months. Slit-lamp examination revealed pupillary dilation, and binocular accommodative function examination indicated accommodation loss. After treatment with 2% topical pilocarpine, all patients reported an improvement in NVA. Among them, we could observe pupillary constriction, recovery of accommodation function, and improved NVA, even discontinuation of pilocarpine in Patient 2.
In younger patients with good central vision, topical pilocarpine might ameliorate accommodation loss and pupillary dilation after mTLT.
本研究阐明了微脉冲经巩膜激光治疗（mTLT）的一种常见且重要的术后并发症，并探讨了针对具有良好中心视力的年轻患者的潜在管理策略。
3 名年轻的中国青光眼患者，他们的中心视力良好，但在最大耐受的局部抗青光眼药物治疗下仍保持着较高的眼内压（IOP）（36、25 和 30mmHg）。所有患者均因滤过性手术并发症风险较高而接受 mTLT 治疗。术后，他们的最佳矫正视力没有明显变化，眼压显著降低，且局部抗青光眼药物的使用量逐渐减少。然而，所有患者均抱怨在 1-5 个月内出现近视力（NVA）下降。裂隙灯检查显示瞳孔散大，双眼调节功能检查提示调节功能丧失。经 2%的局部毛果芸香碱治疗后，所有患者均报告 NVA 改善。其中，我们可以观察到瞳孔收缩、调节功能恢复和 NVA 改善，甚至在患者 2 中停用了毛果芸香碱。
在具有良好中心视力的年轻患者中，局部毛果芸香碱可能改善 mTLT 后出现的调节功能丧失和瞳孔扩张。
