Kampmeier J, Klafke M, Hibst R, Wierschin S, Schütte E, Steiner R
Abt. Ophthalmologie, Bundeswehrkrankenhaus Ulm, Akademisches Krankenhaus, Universität Ulm.
Klin Monbl Augenheilkd. 1996 Apr;208(4):218-23. doi: 10.1055/s-2008-1035199.
Results over a period of 24 months of performing the Er:YAG laser ab externo sclerostomy.
The procedure was performed 81 times (chronic glaucoma with open angle (n = 55) and narrow angle (n = 15), 6 secondary glaucoma, 4 pigment glaucoma, 1 normal pressure glaucoma) in 74 eyes of 64 patients at the age of 70 +/- 10 years without any peribulbar anesthesia. The pulse energy was 11 mJ with a repetition rate of 7 Hz. Antimetabolites were not applicated. Success was defined as an IOP of less than 22 mm Hg or a decrease of at least 30%, with or without anti-glaucoma medication.
The mean IOP of all cases decreased from preoperatively 28 +/- 8.1 mm Hg (Success group: 26.7 +/- 7.3 mm Hg) to 15 +/- 8.4 mm Hg (Success group: 14.6 +/- 7.8 mm Hg) on the first postoperative day. The success rate was about 50% within the period of two weeks to six months and decreased to about 15% in the 24th month. Complications were iris incarceration/synechia (n = 33), hypotony (n = 36) with consequent choroidal detachment (n = 8), hyphema (n = 19) and more pronounced inflammation symptoms (n = 10). In most cases, the early postoperative outflow failure is caused by iris incarceration into the internal ostium. The scarring tendency of the episcleral tissue leads to closure of the external ostium after months. Resurgery was necessary in 26 cases.
Further efforts should be directed to maintain the intact corneoscleral morphology of the canal, created by an optimized method of the surgical technique. The application of antimetabolites in correct dosage or the implantation of modified silicon draining systems would be helpful.
对连续24个月行铒激光外路巩膜造瘘术的结果进行分析。
对64例年龄为70±10岁的患者的74只眼睛进行了81次该手术（开角型慢性青光眼55例，闭角型青光眼15例，继发性青光眼6例，色素性青光眼4例，正常眼压性青光眼1例），术中未使用球周麻醉。脉冲能量为11 mJ，重复频率为7 Hz。未应用抗代谢药物。成功定义为眼压低于22 mmHg或至少降低30%，无论是否使用抗青光眼药物。
所有病例的平均眼压从术前的28±8.1 mmHg（成功组：26.7±7.3 mmHg）降至术后第1天的15±8.4 mmHg（成功组：14.6±7.8 mmHg）。在术后2周内至6个月期间成功率约为50%，在第24个月时降至约15%。并发症包括虹膜嵌顿/粘连（33例）、低眼压（36例）及随之而来的脉络膜脱离（8例）、前房积血（19例）和更明显的炎症症状（10例）。在大多数情况下，术后早期引流失败是由虹膜嵌顿入内口所致。巩膜组织的瘢痕化倾向导致数月后外口闭合。26例患者需要再次手术。
应进一步努力通过优化手术技术来维持巩膜管完整的角膜巩膜形态。正确剂量抗代谢药物的应用或改良硅引流系统的植入可能会有所帮助。
