Walland M J
Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
Aust N Z J Ophthalmol. 1998 May;26(2):135-9. doi: 10.1111/j.1442-9071.1998.tb01529.x.
Ciliary body ablation in end-stage glaucoma has been widely performed with cryotherapy and neodymium:yttrium aluminium garnet (Nd:YAG) laser, both techniques frequently involving considerable pain and postoperative inflammation, with an unpredictable final intraocular pressure (IOP) and a significant risk of phthisis. Diode laser cyclophotocoagulation (cyclodiode laser) has recently been introduced in an attempt to avoid some of these problems.
Thirty patients with uncontrolled IOP and advanced glaucoma were divided on clinical grounds into two groups and were treated with either a half or a full standardized dose of laser (40 x 1500 mW for 1500 ms) and monitored for IOP control, visual acuity, postoperative inflammation and phthisis. Success of IOP control was defined as IOP < 22 mmHg or a decrease in IOP of > 30%; preservation of visual acuity or control of pain in blind eyes was also assessed.
A sustained lowering of IOP was achieved in 90% of patients, with a mean follow up of 10.4 months. For the full treatment cases (group A), mean (+/-SD) pre-operative and postoperative IOP was 49.4 +/- 11.2 and 25.8 +/- 17.7 mmHg, respectively (a 48% reduction); 55% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction of > 30%. For the half-treatment cases (group B). the mean pre-operative and postoperative IOP was 29.4 +/- 4.3 and 18.9 +/- 5.7 mmHg, respectively (a 36% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Neovascular glaucoma was present in 60% of patients; the full-treatment subgroup of these patients achieved a mean lowering of IOP of 58%. Of 22 sighted eyes, 11 (50%) recorded no change in vision; seven (32%) eyes lost and four (18%) eyes gained vision; pain control was achieved in six of eight blind eyes (75%). There was no significant postoperative inflammation, one case of hypotony and no suggestion to date of sympathetic ophthalmia.
Diode laser cyclophotocoagulation appears to be simple, safe and is frequently successful in the control of IOP in end-stage glaucoma. Optimum dosage parameters remain to be determined.
在终末期青光眼患者中，睫状体消融术已广泛采用冷冻疗法和钕：钇铝石榴石（Nd:YAG）激光进行，这两种技术常常伴随着相当程度的疼痛和术后炎症，最终眼压（IOP）不可预测，且存在眼球痨的重大风险。二极管激光睫状体光凝术（睫状体二极管激光）最近被引入，试图避免其中一些问题。
30例眼压控制不佳的晚期青光眼患者根据临床情况分为两组，分别接受半量或全量标准化激光治疗（40×1500毫瓦，持续1500毫秒），并监测眼压控制情况、视力、术后炎症及眼球痨情况。眼压控制成功定义为眼压<22 mmHg或眼压降低>30%；还评估了视力的保留情况或盲眼中疼痛的控制情况。
90%的患者眼压持续降低，平均随访10.4个月。全量治疗组（A组）术前和术后平均（±标准差）眼压分别为49.4±11.2和25.8±17.7 mmHg（降低48%）；55%的患者眼压<22 mmHg，68%的患者眼压降低>30%。半量治疗组（B组）术前和术后平均眼压分别为29.4±4.3和18.9±5.7 mmHg（降低36%）；63%的患者眼压<22 mmHg，50%的患者眼压降低>30%。60%的患者患有新生血管性青光眼；这些患者的全量治疗亚组平均眼压降低58%。在22只视力正常的眼中，11只（50%）视力无变化；7只（32%）眼视力下降，4只（18%）眼视力提高；8只盲眼中有6只（75%）疼痛得到控制。术后无明显炎症，1例发生低眼压，至今未出现交感性眼炎迹象。
二极管激光睫状体光凝术似乎简单、安全，且在控制终末期青光眼眼压方面常常取得成功。最佳剂量参数仍有待确定。
