摘要目的 探讨选择性激光小梁成形术(SLT)替代药物治疗POAG的疗效和安全性.方法 前瞻性、随机、对照研究.采用SOLO(R) SLT掺钕钇铝石榴石激光治疗仪对正在接受抗青光眼药物治疗,眼压控制≤21 mmHg(1 mmHg =0.133 kPa)的进展期POAG患者45例(67只眼)进行SLT治疗.采用简单随机化的方法生成随机数字表,将患者随机分为两组,一组为标准能量治疗组:34只眼接受标准能量270°前房角小梁网SLT治疗;另一组为阈下能量治疗组:33只眼接受阈下能量360°前房角小梁网SLT治疗.观察患者治疗前后的眼压,日眼压曲线,抗青光眼药物数量及并发症等指标.随访时间6～9个月,平均6.4个月.符合正态分布的连续变量,如基本资料、日眼压波动、激光能量使用双侧t检验或配对t检验.不符合正态分布的变量,用药种类使用非参数检验的Mann-Whitney U 检验或Wilcoxon rank检验.计数资料成功率和并发症采用卡方或确切概率法检验.结果 治疗前标准能量治疗组和阈下能量治疗组抗青光眼药物种类分别为(2.3±0.5)种和(2.1±0.4)种,治疗后最后一次随访用药种类分别为(1.3±0.5)种和(1.1±0.3)种,治疗前后用药种类差异具有统计学意义(Z=-5.477,-5.396;P ＜0.05).标准能量治疗组和阈下能量治疗组治疗成功率分别为91.1％ 和87.9％ (P-0.70).标准能量治疗组和阈下能量治疗组日眼压波动在治疗前分别为(3.6±1.0) mmHg和(3.9±1.4)mmHg,治疗后分别为(2.3±1.0)mmHg和(2.4±0.9)mmHg,治疗前后差异具有统计学意义(t=4.911,4.679;P＜0.05).标准能量治疗组激光治疗总能量为(47.8±6.0) mJ高于阈下能量治疗组(43.2±5.1) mJ(t =12.006,3.233;P ＜0.05),两组间在日眼压波动,治疗成功率、减少药物种类、治疗前后眼压及并发症等方面无明显差异.结论 SLT作为POAG患者抗青光眼药物替代治疗的方法,可以安全有效地减少患者用药的种类.阈下能量360°前房角小梁网SLT和标准能量270°前房角小梁网SLT治疗效果没有明显差异.

abstractsObjective To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT)as a replacement for medical therapy in primary open-angle glaucoma (POAG).Methods A prospective,randomized,controlled study.SLT treatment with SOLO (R) SLT Nd∶ YAG laser was provided to 45 participants with advanced POAG (67 eyes,IOP ≤ 21 mmHg,1 mmHg =0.133 kPa) under antiglaucomatous medications control).A table of random numbers was created by simple randomization method.Participants were randomly divided into two groups:the standard-energy group (34 eyes),which received a 270° standard-energy SLT treatment and the sub-threshold energy group (33 eyes),which received a 360° sub-threshold energy treatment.Thc intraocular pressure (IOP) before and after SLT,daytime IOP curve,dosage of anti-glaucoma drugs and treatment complications were observed,which were be followed up for 6-9 months (average 6.4 months).Two-tailed t-test or paired t test was used when the continuous variables were normal distribution,such as the basic data,daily fluctuations of IOP,laser energy.Non-parametric Mann-Whitney U test or Wilcoxon rank test was used when data was not distributed normally,such as drug category.Chi-square or Fisher's exact test was used when count variables such as success rate and complications were analyzed.Results The number of anti-glaucomatous drugs used in the standard-energy group and the sub-threshold energy group before SLT was (2.3 ± 0.5) and (2.1 ± 0.4),respectively; whereas,after the last treatment,it reduced to (1.3 ±0.5) and (1.1 ±0.3),respectively (Z =-5.477,-5.396 ; P ＜ 0.05).The success rate of the standard-energy group and the sub-threshold energy group was 91.1％,and 87.9％,respectively,which was not significant different (P =0.70).Laser treatment was found to reduce the IOP fluctuation during the daytime.IOP fluctuation decreased from (3.6 ± 1.0) mmHg to(2.3 ± 1.0) mmHg in the standard-energy group,and decreased from(3.9 ± 1.4) mmHg to (2.4 ±0.9) mmHg in the sub-threshold energy group,which was significant different (t=4.911,4.679;P ＜ 0.05).The total laser energy of the standard-energy group (47.8 ± 6.0) mJ was higher than the subthreshold energy group (43.2 ± 5.1) mJ (t =12.006,3.233 ;P ＜ 0.05).However,there was no significant difference in the daily IOP fluctuations,success rate,reduction of medication categories,preoperative and postoperative IOP,and adverse reactions between the two groups.Conclusions SLT is a safe and effective replacement for medical therapy in primary open-angle glaucoma treatment.SLT could reduce the applications of anti-glaucoma drugs.There was no significant difference between therapeutic effects of which eyes received 360° sub-threshold energy and 270° standard-energy.