摘要目的 探讨低能量选择性激光小梁成形术( SLT)的临床疗效.方法 前瞻性临床对照研究.选择高眼压症和原发性开角型青光眼患者74例(74只眼),以SLT作为初始治疗方法.将患者分为两组:低能量组39例(39只眼),使用常规能量的1/2治疗；对照组35例(35只眼),使用常规能量治疗.术后随访1年,观察两组患者眼压和并发症的动态变化.两组患者各随访时间点的治疗有效率比较和并发症总发生率比较均采用X2检验.结果 患者治疗后2周,1、3、6及12个月的治疗有效率(眼压下降值≥20％基线眼压):在低能量组的高眼压症患者(11只眼)中,分别有9、7、7、7、5只眼治疗有效,有效率分别为81.81％、63.63％、63.63％、63.63％、45.45％；原发性开角型青光眼患者(18只眼)中,分别有15、16、13、12、8只眼治疗有效,有效率分别为83.33％、88.88％、72.22％、66.66％、44.44％.在对照组的高眼压症患者(10只眼)中,分别有5、7、6、4、5只眼治疗有效,有效率分别为50.00％、70.00％、60.00％、40.00％、50.00％；原发性开角型青光眼患者(19只眼)中,分别有16、14、11、11、9只眼治疗有效,有效率分别为84.21％、73.68％、57.89％、57.89％、47.36％.低能量组与对照组间各随访时间点的治疗有效率比较(高眼压症:x2 =2.386,0.096,1.173,1.110,0.043;原发性开角型青光眼:x2 =0.005,1.393,0.833,0.302,0.032),差异均无统计学意义(P＞0.05).低能量组(39只眼)中有8只眼(20.51％)出现至少一种并发症(包括结膜充血、轻度前葡萄膜炎),对照组中有15只眼(42.85％)出现至少一种并发症(包括结膜充血、轻度前葡萄膜炎、眼部轻度疼痛、一过性高眼压、周边虹膜前粘连)；两组间并发症总发生率差异有统计学意义(x2=4.299,P＜0.05).结论 低能量SLT较之常规能量SLT具有近似的降眼压效果和更少的并发症,是一种安全、有效的降眼压方法.

abstractsObjective To evaluate the efficacy of low-energy selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) following up to one year.Methods In this prospective clinical study,seventy-four eyes of seventy-four patients with OHT and POAG were enrolled.Thirty-nine patients received low-energy treatment using half of conventional laser energy and 100 spots over 360° of the trabecular meshwork,while thirty-five patients received conventional laser energy as control.Intraocular pressure (IOP) and complications including conjunctival hyperemia and anterior uveitis were followed up at week 2,and month 1,3,6,and 12.Effective rate (reduction of IOP≥20％ ) of treatment between the two groups and total rate of complications were analyzed by the chi-squared test.Results In OHT group,the effective rates of treatment were81.81(9/11),63.63 (7/11),63.63( 7/11 ),63.63 (7/11 ),and 45.45％ (5/11 ) in the low-energy group and 50.00 (5/10),70.0 (7/10),60.0 (6/10),40.0 (4/10),and 50.0％ (5/10) in the control group,at weeks 2,month 1,3,6,and 12after treatment respectively,while in POAG,the effective rates were 83.33 (15/18),88.88 (16/18),72.22 (13/18),66.66 (12/18),and 44.44％ (8/18) in the low-energy group and 84.21 (16/19),73.68 (14/14),57.89 (11/19),57.89 (11/19) and 47.37％ (9/19) in the control group at weeks 2,month 1,3,6,and 12 after treatment,respectively.There were no statistical difference between the low energy and conventional energy group at all time points in OHT ( x2 =2.386,0.096,1.173,1.110,0.043)and POAG ( x2 =0.005,1.393,0.833,0.302,0.032) group( P ＞ 0.05 ).Complications were significantly ( x2 =4.299,P ＜ 0.05 ) different between the two groups ( eight eyes in the low-energy group on the day of treatment and fifteen eyes in the control group).Transient IOP spike ( ≥3 mm Hg,1 mm Hg =0.133 kPa)occurred in three eyes (in the control group) on the day of treatment and partial peripheral anterior synechiae in one eye ( in the control group) one month after treatment.Conclusions Low-energy SLT is as effective in lowering IOP with less complications compared with conventional laser energy SLT,which can be considered as an option for glaucoma therapy.