Effectiveness of unilateral selective laser trabeculoplasty for primary open angle glaucoma

目的 观察单眼选择性激光小梁成形术(SLT)对双眼POAG患者双眼降眼压的疗效.方法 采用自身对照临床研究.研究对象为2010年2月至2014年4月在北京大学第三医院眼科长期就诊的双眼POAG患者32例,双眼应用相同降眼压药物治疗,对眼压较高的一只眼行SLT治疗.术前及术后1h、1周、1个月、3个月和6个月进行相关检查,除SLT后1h时只检查眼压(Goldmann眼压计)外,其余时间点均进行视力、眼压、裂隙灯显微镜、眼底及视野检查.以眼压下降≥3.0 mmHg,或者下降幅度≥20％为激光治疗成功标准,采用配对t检验(bonferroni矫正)比较激光后各个时间点眼压与激光前的基线眼压;采用单因素方差分析对眼压下降幅度百分比进行比较;采用线性相关分析,对治疗眼和未治疗的对侧眼术后6个月时眼压下降的幅度以及各自和术前基线眼压进行相关分析,对抗青光眼药物应用种类和术后6个月眼压下降的幅度进行相关分析.结果 双眼POAG患者SLT术前治疗眼基线眼压为(18.9±2.5)mmHg(1mmHg=0.133 kPa),激光后1周、1个月、3个月、6个月平均眼压下降值分别为:(1.7±2.9)mmHg、(2.5±3.4)mmHg、(3.5±2.8)mmHg、(3.4±2.5)mmHg,眼压下降幅度为(8±16)％、(13±13)％、(18±14)％、(18±12)％(与基线比P均＜0.01).SLT后1周、1个月、3个月、6个月时的治疗眼成功率分别为38％、52％、50％、60％.未治疗的对侧眼激光前基线眼压为(17.3±2.4)mmHg,激光后1周、1个月、3个月、6个月眼压下降平均值分别为:(1.1±2.0) mmHg、(1.0±2.7) mmHg、(2.6±2.2) mmHg、(2.5±2.2)mmHg(与基线比P均＜0.01).术后6个月时治疗眼和未治疗的对侧眼眼压下降的幅度分别和术前眼压呈正相关(R=0.63,P＜0.01;R=0.60,P＜0.01).术后6个月时治疗眼和未治疗眼眼压下降的幅度呈正相关(R=0.66,P＜0.01).所有患者均不需再次激光治疗或者手术治,抗青光眼药物应用均维持了与术前相同的方法.结论 对于降眼压药物治疗眼压控制不良、平均眼压在18.0 mmHg左右的双眼POAG患者,单眼STL术后6个月术眼眼压进一步降低,对对侧未治疗眼的眼压也有一定的持续降眼压作用.Objective To study the effectiveness of unilateral selective laser trabeculoplasty (SLT) on the both eyes of patients with primary open-angle glaucoma (POAG).Methods This was a self-controlled clinical study.Thirty-two patients of 32 eyes with OAG who used same anti-glaucoma medications for both eyes were included aat the Department of Ophthalmology Peking University third Hospital from February 2010 to April 2014.SLT was performed for the poorly controlled eye for each patient.Patients were examined before operation and 1 hour,1 week,1 month,3 months and 6 months after operation.The intraocular pressure was examined after 1 hour of SLT.The rest time points were examined by visual acuity,intraocular pressure (IOP),slit lamp microscope,fundus ophthalmoscope and visual field.The paired t test (Bonferroni) was used to compare the IOP at each time point after SLT with the baseline IOP before SLT.Single factor analysis of variance was used to compare the percentage of IOP drop.Linear correlation analysis was used to analyze the amplitude of the decrease of IOP between treated eyes and untreated eyes at 6-month post-operatively and analyze the IOP between preoperative eyes and 6-month post-operative eyes.The magnitude of the decrease of IOP in patients with glaucoma medication and 6 months after surgery was analyzed.We also analyzed the types of antiglaucoma medications and IOP reductions range for 6 month after SLT.Results The preoperative mean IOP was (18.9±2.5) mmHg(1 mmHg=0.133 kPa) in the treated eye of patients with OAG.Mean IOP reduction for 1 week,1,3,and 6 months after SLT were (1.7±2.9) mmHg,(2.5±2.5)mmHg,(3.5±2.8)mmHg,(3.4±2.5)mmHg and the percentage of IOP reduction were (8±16)％,(13±13)％ (18±14)％,(18±12)％ respectively (compared with the baseline,P＜ 0.05).With the success criteria of IOP reduction ≥3.0 mmHg or ≥20％,the success rate of SLT in the treated eye after 1 week,1,3,6 months was 38％,52％,50％ and 60％ respectively.For the untreated fellow eyes,the preoperative mean IOP was (17.3±2.4) mmHg.Mean IOP reduction for 1 week,1month,3 month,and 6 month after SLT were (1.1 ± 2.0) mmHg,(1.0 ± 2.7) mmHg,(2.6 ± 2.2) mmHg and (2.5 ± 2.2) mmHg respectively (compared with the baseline,P＜0.05).There was a positive correlation between preoperative IOP and IOP reduction either in the treated or in the untreated eyes at 6-month post-SLT(R=0.63,P＜0.01;R=0.60,P＜0.01).There was a positive correlation in IOP reduction between treated eyes and untreated eyes at 6-month post-operative (R=0.66,P＜0.01).All patients didn't need further treatment such as another laser treatment or surgery.Anti-glaucoma medications were remained unchanged after SLT.Conclusions In poorly anti-glaucoma medication controlled Chinese POAG eyes with mean IOP about 18.0 mmHg,unilateral STL can reduce the IOP about 18％ at 6-month post-operative for the treated eyes.There was also a continuous IOP reduction effects for the fellow eyes.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)6410-4155