作者：田艳明，高晓唯，余爱萍，任兵，王瑞夫 作者单位：830001）中国新疆维吾尔自治区乌鲁木齐市，中国人民解放军474医院全军眼科中心
【摘要】 目的：探讨选择性激光小梁成形术（selective laser trabeculoplasty，SLT）对部分特殊类型眼压升高患者的降眼压效果。这些患者不适宜或者不接受抗青光眼手术治疗
【关键词】 选择性激光小梁成形术；眼内压
Effect of selective laser trabeculoplasty on special patients of high IOP YanMing Tian, XiaoWei Gao, AiPing Yu, Bing Ren, RuiFu Wang Eye Center, the 474th Hospital of Chinese PLA, Uramochi 830001, Xinjiang Uygur Autonomous Region, China Abstract AIM: To explore the effect of selective laser trabeculoplasty(SLT) on special patients with high IOP who were not suitable for or did not accept glaucoma operation METHODS: Ten patients whose IOP was high were investigated. Of them, 1 patient had no lenses after removing silicone oil; 3 patients were ever operated on by trabeculoplasty(one eye were operated twice in Aserbaidschan). 3 patients were diagnosed as ocular hypertension, 1 patient was padded with silicon oil, 2 patients were absolute glaucoma(one was open angle glaucoma, one was angleclosure glaucoma). All these patients were treated with SLT( 80120 non overlapping spots were placed over 180 upper angle or inferior angle according to IOP level. Primary angleclosure glaucoma were first treated with laser aridotomy,after that,when IOP of these eyes was over 21mmHg,the patients were treated with SLT). RESULTS: The average preoperation IOP of these 10 eyes was 28.9±5.4mmHg(the limits of IOP was 2240mmHg). IOP 1 day, 1 week, 1 month and 6 months after SLT was 21.6±6.5mmHg, 24.3±6.01mmHg, 22.2±63mmHg, 21.4±5.2mmHg respectively. There were 6 eyes whose IOP was less than 21mmHg with no use of medcine; the treatment of some cases needed to be repeated. The IOPs of all these eyes were less than 21mmHg after the use of one kind of eye drops which can reduce IOP. No apparent inflammatory reaction in anterior chamber was seen. A few patients felt little pain and light discomfortable. CONCLUSION: SLT is a safe, effective and selectable treatment for special patients with high IOP who are not suitable for glaucoma operation.
KEYWORDS: selective laser trabeculoplasty; intraocular pressure
方法：临床观察10例高眼压患者,其中硅油取出后无晶状体高眼压1例,青光眼术后3例(其中1例在阿塞拜疆行二次抗青光眼手术), 未确诊青光眼的高眼压症3例,硅油充填术后1例,绝对期青光眼2例(其中开角1例,闭角1例)，根据眼压范围行Nd:YAG激光SLT治疗(选择上方或下方180°范围内治疗，原发性闭角型青光眼行激光周边虹膜成形术和激光周边虹膜切除术后眼压＞21mmHg的再行选择性激光小梁成形术)。
结果：SLT 10眼术前平均眼压28.9±5.4mmHg(眼压22～40mmHg)；术后1d；1wk；1，6mo眼压分别为21.6±6.5mmHg，24.3±6.01mmHg，22.2±63mmHg，21.4±5.2mmHg。SLT术后6mo不用药物眼压≤21mmHg有6眼；部分患者需要重复治疗，全部患者加用1种降眼压药物眼压≤21mmHg, 未出现明显的前房炎症反应，少部分患者在治疗时有轻微的疼痛及不适感。
结论：SLT对于不适宜抗青光眼手术治疗的一些特殊类型的高眼压患者, 是安全有效、费用低廉的可供选择的降眼压方法。
0引言 我院200712/200806门诊接诊10例特殊类型高眼压患者,使用选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗，经6mo随访,效果比较理想，现将治疗情况报告如下。
1对象和方法 1.1对象 硅油取出后无晶状体高眼压1例，男，29岁,该患者硅油取出术后行170mL/L SF6气体充填,俯卧位休息,眼压波动于29～35mmHg,口服醋甲唑胺,局部点用派利明控制眼压，1mo后，气体完全吸收,该患者不使用药物的情况下，眼压波动于27～29mmHg，并且视野损害扩大,行SLT上方180°范围内激射52点，治疗后1wk不使用药物，眼压21～23mmHg，行二次激光，随访3mo,眼压控制于17～19 mmHg，视野有所扩大，视力稳定,3mo后失访。青光眼术后3例(其中1例在阿塞拜疆行二次抗青光眼手术)，其中慢性闭角型青光眼1例，女，49岁，维族，左眼在我院行抗青光眼手术，眼压控制良好，右眼2a前在外院行小梁切除+虹膜周切术，眼压波动于28～30mmHg，术后长期药物控制眼压，查体右眼视力0.5，前房中央深约3CT，视神经萎缩，视野为管状，行右眼SLT治疗，上方180°范围内激射52点，治疗2wk后不使用药物，右眼眼压22mmHg，加用贝特舒眼药，眼压15～17mmHg。开角型青光眼非穿透小梁切除术1例，男51岁，术后0.5a眼压25～27mmHg。SLT激光治疗后，眼压稳定18mmHg以下。1例开角型青光眼，43岁，男，阿塞拜疆族，左眼在阿塞拜疆行二次抗青光眼手术，眼压30～35mmHg,视野呈管状，SLT激光治二次，间隔2wk，使用一种降眼压药物，眼压控制于18～21mmHg。硅油注入术后高眼压1例，70岁，女，左眼硅油注入术后2wk，眼压25～27mmHg，SLT激光治疗后眼压稳定于14～16mmHg，随访期间眼压稳定，术后10mo行硅油取出。绝对期青光眼2例，均系维族男性，无用药史，伴有慢性头痛，双目失明。1例72岁，为开角型青光眼压，眼压35～37mmHg, SLT激光治疗后,双眼眼压28～29mmHg；1例68岁，为慢性闭角型青光眼，眼压38～40mmHg，先给予左眼YAG激光虹膜周切，1wk后，行SLT激光治疗,眼压28～29mmHg,两患者加用一种降眼压药物后,眼压<25mmHg。高眼压症3例,视野及OCT神经纤维测厚，均未发现异常，1例男，43岁,因家人有青光眼，而就诊,眼压23～25mmHg, 1例45岁女，外院诊断为高眼压症，就诊眼压24～26mmHg；1例23岁女，近视患者，拟行准分子激光角膜原位磨镶术，术前检查，眼压22～25mmHg，因眼压高，激光医生不考虑为该患者手术。该3例患者SLT激光治疗二次后眼压稳定于21mmHg以下。1mo后，近视患者行LASIK手术。确诊为青光眼的患者术前继续使用降压药物。
1.2方法 爱尔凯因5g/L表面麻醉，采用国通医疗代理的澳大利亚ELLEX眼科激光治疗机。激光波长532nm，脉冲时间3ns，光斑400μm，所选能量为0.4～1.4MJ，患者坐在裂隙灯前，置房角镜，将氦―氖瞄准光聚焦于色素小梁网上，激光能量首先设置在0.5MJ，然后以0.1MJ递增直到观察到出现气泡，然后再减0.1MJ即是“治疗能量”，单一脉冲52个非重叠激光斑照射上方或下方180°小梁网范围。术后局部点典必殊眼药水1wk，降眼压药同术前。术后1d；1wk；1，6mo观察眼压。
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