Wetzel W, Häring G, Brinkmann R, Birngruber R
University Eye Hospital Kiel, Clinic for Ophthalmology, Germany.
Ger J Ophthalmol. 1994 Mar;3(2):112-5.
A new approach to fistulating glaucoma surgery, laser sclerostomy ab externo, was investigated in a clinical study. A pulsed (200 microseconds) erbium-YAG laser was used, as its wavelength (2940 nm) is very well absorbed by tissue water. The laser energy was transmitted via a fiber to an application probe with a cannula particularly designed to guide another fiber into the subconjunctival space. Nine patients with advanced open-angle or neovascular glaucoma were treated. In all cases a functioning fistula with a prominent filtering bleb and a reduction of the intraocular pressure (from up to 50 mmHg to 8-18 mmHg) could be achieved. The total energy was 60 mJ on average. No complication occurred intraoperatively. Postoperatively, all fistulas in patients with neovascular glaucoma (n = 6) were impatent after approx. 7 days due to iris adherence to the internal ostium and episcleral scarring. In cases of open-angle glaucoma (n = 3) a patent fistula persisted for several months. Variation of the exposure parameters, the use of antiproliferative drugs, and a less restrictive selection of patients could further improve the success rate.
在一项临床研究中，对一种新的青光眼造瘘手术方法——经外路激光巩膜造瘘术进行了研究。使用了脉冲（200微秒）铒钇铝石榴石激光，因为其波长（2940纳米）能被组织中的水很好地吸收。激光能量通过光纤传输到一个带有套管的应用探头，该套管经过特殊设计，可引导另一根光纤进入结膜下间隙。对9例晚期开角型或新生血管性青光眼患者进行了治疗。在所有病例中，均成功形成了有明显滤过泡且眼压降低（从高达50毫米汞柱降至8 - 18毫米汞柱）的功能性瘘管。平均总能量为60毫焦。术中未发生并发症。术后，新生血管性青光眼患者（n = 6）的所有瘘管在大约7天后因虹膜粘连至内口和巩膜表面瘢痕形成而闭塞。在开角型青光眼患者（n = 3）中，一个通畅的瘘管持续了数月。改变暴露参数、使用抗增殖药物以及放宽患者选择标准可能会进一步提高成功率。
