摘要目的 观察二极管激光经巩膜睫状体光凝(transcleral cyclophotocoagulation)治疗难治性青光眼的疗效及安全性.方法 临床病例对照研究.自2009年1月至2012年12月间,在天津市眼科医院共收治各类难治性青光眼患者162例(162只眼),其中男76例,女86例；平均年龄(54.7±12.3)岁(22～81岁).按青光眼诊断类型分为三组:滤过性手术后开角型青光眼组51例,闭角型青光眼组50例,新生血管青光眼组61例,所有患者对既往药物及手术治疗效果均不理想,眼压持续升高.所有患者接受二极管激光经巩膜睫状体光凝治疗,随访观察三组患者治疗前后眼压、前房深度和视力改变.结果 三组患者经治疗后眼压明显下降,差异有统计学意义(F =3.84,P=0.024,P＜0.05),治疗后各组患者之间眼压差异无统计学意义(F =0.99～1.84,P＞0.05).末次随访时平均眼压较治疗前下降54.2％,其中达到临床治愈标准者124例,手术有效率为76.5％.治疗后三组患者平均前房深度均有加深,差异有统计学意义(t =6.21,P=0.000,P＜0.05).其中以闭角型青光眼改变明显(t=7.64,P =0.000,P＜0.05),开角型青光眼和新生血管青光眼患者差异无统计学意义(t=1.85,1.86,P=0.07,P＞0.05).治疗后最佳矫正视力有轻度改善者27例(16.7％),视力稳定者112例(69.1％),视力下降者23例(14.2％).患者对手术耐受良好,少数患者出现轻度前葡萄膜炎、前房出血或角膜水肿,但无低眼压、眼球萎缩及交感性眼炎发生.结论 二极管激光经巩膜睫状体光凝术对难治性青光眼具有良好地降眼压效果,且操作简单、安全有效和患者痛苦小,可作为难治性青光眼的有效治疗手段.

abstractsObjective To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation (TSCP) in the treatment of refractory glaucoma.Methods From January 2009 to December 2012,a total of 162 eyes (162 patients) with advanced glaucoma refractory to medical treatment in Tianjin Eye Hospital were collected.The male patients were 76 cases and the females were 86cases.The average age was (54.7±12.3) years old (range 22-81 years).There were 51 cases with primary open angle glaucoma (POAG),50 cases with primary angle-closure glaucoma (PACG) and 61cases of patients with neovascular glaucoma (NVG).All the affected eyes had higher intraocular pressure (IOP) even through the maximal medication.All the patients were undergone the TSCP treatment.The IOP,anterior chamber depth,corrected visual acuity and complications were observed and follow-up.Results The mean postoperative IOP was decreased and the difference was significant before and after the treatment (F=3.84,P =0.024),the postoperative IOP at the different groups were not significant difference (F=0.99-1.84,P ＞0.05).The IOP decreased rate was 54.2％ between the first and the last visit.The success rate was 76.5％ after twelve months follow-up.The anterior chamber depth of all patients was deeper after the treatment and the difference was significant (t =6.21,P =0.000).The anterior chamber depth of the patients with PACG was changed significantly (t =7.64,P =0.000) and there was no significant difference (t =1.85/1.86,P =0.07) among the patients with POAG and NVG.Compared to the initial visit,the corrected visual acuity at last visit was increased in 27 cases (16.7％) of the patients,112 cases (69.1％) was stable and 23 cases (14.2％) was decreased.Most of the patients were tolerant with the treatment,and some patients had slight anterior uveitis,hyphema or corneal edema.There was not hypotension,sympathetic ophthalmia or phthisis bulbi.Conclusions TSCP can decrease the intraocular pressure evidently and relieve pain from the patients with refractory glaucoma.It is an effective,simple and safe method for the treatment of refractory glaucoma.