Latina M A, Sibayan S A, Shin D H, Noecker R J, Marcellino G
Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Ophthalmology. 1998 Nov;105(11):2082-8; discussion 2089-90. doi: 10.1016/S0161-6420(98)91129-0.
To investigate the safety and efficacy of a new laser procedure using a q-switched 532-nm neodymium (Nd):YAG laser, also called "selective laser trabeculoplasty," to lower intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). The laser parameters were set to selectively target pigmented trabecular meshwork (TM) cells without coagulative damage to the TM structure or nonpigmented cells.
Nonrandomized, prospective, clinical trial.
Thirty eyes of 30 patients with uncontrolled OAG (OAG group) and 23 eyes of 23 patients with uncontrolled OAG treated previously with argon laser trabeculoplasty (ALT group) were observed for 4 to 26 weeks. Forty-four of the 53 eyes were observed for 26 weeks.
Patients were treated with the Coherent Selecta 7000 (Coherent, Inc, Palo Alto, CA) frequency-doubled q-switched Nd:YAG laser (532 nm). A total of approximately 50 nonoverlapping spots were placed over 180 degrees of the TM at energy levels ranging from 0.6 to 1.2 mJ per pulse. After surgery, patients were maintained with the identical drug regimen as that before treatment.
Both the OAG and ALT groups showed similar IOP reductions over time. Seventy percent of patients in each group responded to treatment with an IOP reduction of least 3 mmHg. At 26 weeks of follow-up, mean IOP reduction was 5.8 mmHg (23.5%, P < 0.001) for the OAG group and 6.0 mmHg (24.2%, P < 0.001) for the ALT group. The untreated eye showed a 9.7% (P < 0.001) reduction of IOP at 26 weeks. However, the IOP difference between the treated and untreated eyes was statistically significant at P < 0.003. Transient IOP elevation of 5 mmHg or greater was seen in 24% of patients.
The selective laser trabeculoplasty appears to be a safe and effective method to lower IOP in patients with OAG and patients treated previously with ALT. A reduction of IOP can be achieved without coagulation of the TM.
研究一种使用调Q开关532纳米钕（Nd）:钇铝石榴石激光的新型激光手术（也称为“选择性激光小梁成形术”）降低开角型青光眼（OAG）患者眼压（IOP）的安全性和有效性。激光参数设定为选择性靶向色素性小梁网（TM）细胞，而不对TM结构或非色素性细胞造成凝固性损伤。
非随机、前瞻性临床试验。
观察30例未经控制的OAG患者的30只眼（OAG组）和23例先前接受氩激光小梁成形术（ALT组）治疗的未经控制的OAG患者的23只眼，观察时间为4至26周。53只眼中的44只观察了26周。
患者接受Coherent Selecta 7000（Coherent公司，加利福尼亚州帕洛阿尔托）倍频调Q Nd:YAG激光（532纳米）治疗。在TM的180度范围内共放置约50个不重叠的光斑，每个脉冲的能量水平为0.6至1.2 mJ。手术后，患者维持与治疗前相同的药物治疗方案。
OAG组和ALT组随时间推移眼压降低情况相似。每组70%的患者对治疗有反应，眼压至少降低3 mmHg。在随访26周时，OAG组平均眼压降低5.8 mmHg（23.5%，P<0.001），ALT组平均眼压降低6.0 mmHg（24.2%，P<0.001）。未治疗的眼在26周时眼压降低9.7%（P<0.001）。然而，治疗眼与未治疗眼之间的眼压差异在P<0.003时具有统计学意义。24%的患者出现了5 mmHg或更高的短暂眼压升高。
选择性激光小梁成形术似乎是降低OAG患者和先前接受ALT治疗患者眼压的一种安全有效的方法。无需凝固TM即可实现眼压降低。
