Chen J, Cohn R A, Lin S C, Cortes A E, Alvarado J A
Department of Ophthalmology, University of California, San Francisco, USA.
Am J Ophthalmol. 1997 Dec;124(6):787-96. doi: 10.1016/s0002-9394(14)71696-4.
To evaluate the safety and efficacy of endoscopic cyclophotocoagulation in the treatment of refractory glaucomas.
The preoperative and postoperative courses of 68 eyes of 68 patients who underwent endoscopic cyclophotocoagulation at our institution were retrospectively reviewed. Study patients had diverse forms of glaucoma, and most had failed maximal medical therapy as well as failed filtration or transscleral cyclodestructive procedures, or both. Endoscopic cyclophotocoagulation treatment encompassed 180 to 360 degrees of the ciliary body circumference and was performed through a limbal incision (56 eyes, 12 of which underwent concurrent cataract extraction) or pars plana incision (12 eyes). A second laser treatment was required in five eyes (7%).
During the mean follow-up period of 12.9 months, mean +/- SD intraocular pressure decreased from 27.7 +/- 10.3 mm Hg preoperatively to 17.0 +/- 6.7 mm Hg at the final postoperative visit (P < .0001), for a mean reduction of 10.7 mm Hg and a mean percent decrease of 34%. Sixty-one eyes (90%) achieved an intraocular pressure < or = 21 mm Hg. Using this definition of success, Kaplan-Meier analysis predicted a successful outcome in 94% of patients after 1 year and 82% after 2 years. The mean number of glaucoma medications used by each patient was reduced from 3.0 +/- 1.3 preoperatively to 2.0 +/- 1.3 postoperatively (P < .0001). Best-corrected visual acuity was stable or improved in 64 eyes (94%), with four (6%) losing 2 or more lines of Snellen acuity. No case of hypotony (intraocular pressure < 5 mm Hg) or phthisis was observed.
These early results suggest that endoscopic cyclophotocoagulation is a safe and effective therapeutic modality for refractory glaucomas.
评估内镜睫状体光凝术治疗难治性青光眼的安全性和有效性。
回顾性分析我院68例患者68只眼行内镜睫状体光凝术的术前及术后病程。研究患者患有多种形式的青光眼，大多数患者最大药物治疗失败，滤过或经巩膜睫状体破坏手术失败，或两者均失败。内镜睫状体光凝治疗包括睫状体圆周180至360度，通过角膜缘切口（56只眼，其中12只眼同时行白内障摘除术）或睫状体平坦部切口（12只眼）进行。5只眼（7%）需要进行第二次激光治疗。
在平均12.9个月的随访期内，平均±标准差眼压从术前的27.7±10.3 mmHg降至术后末次随访时的17.0±6.7 mmHg（P <.0001），平均降低10.7 mmHg，平均降低百分比为34%。61只眼（90%）眼压≤21 mmHg。采用此成功定义，Kaplan-Meier分析预测1年后94%的患者和2年后82%的患者治疗成功。每位患者使用的青光眼药物平均数量从术前的3.0±1.3降至术后的2.0±1.3（P <.0001）。64只眼（94%）最佳矫正视力稳定或提高，4只眼（6%）Snellen视力下降2行或更多。未观察到低眼压（眼压<5 mmHg）或眼球萎缩病例。
这些早期结果表明，内镜睫状体光凝术是治疗难治性青光眼的一种安全有效的治疗方式。
