超声睫状体成形术治疗难治性青光眼的疗效及安全性

Efficacy and safety of ultrasound cycloplasty in the treatment of refractory glaucoma

摘要:

目的：探讨超声睫状体成形术治疗难治性青光眼的安全性及临床有效性。

方法：前瞻性研究。收集2021-06/2022-10在我院就诊的难治性青光眼患者17例17眼，均行超声睫状体成形术治疗。随访6 mo，记录患者眼压、疼痛等级评分、降眼压药物使用、手术成功率以及并发症发生情况。

结果：术后1 d(32.54±13.21 mmHg)、1 wk(22.38±11.98 mmHg)、1 mo(22.63±10.78 mmHg)、3 mo(26.05±9.17 mmHg)、6 mo(23.73±9.60 mmHg)，均较术前眼压(51.98±7.80 mmHg)下降(均P<0.01)； 术后各时间节点眼压降低率依次为36.25%、57.10%、56.35%、49.16%、54.09%。术后疼痛等级评分较术前下降(P<0.01)。术后降眼压药物使用数量较术前减少(P=0.008)。术后6 mo时完全成功2眼(12%)，部分成功11眼(65%)，失败4眼(24%)。术后1 d发生前房炎性反应1眼(6%)、异物感2眼(12%)、结膜下出血2眼(12%)、结膜充血6眼(35%)，所有症状均在1 wk内自行消失。术后10 d发生脉络膜脱离1眼(6%)，经口服醋酸泼尼松片治疗1 mo后恢复。未见前房积血、瞳孔异位、虹膜黏连、黄斑水肿等严重并发症。

结论：超声睫状体成形术治疗难治性青光眼可有效降低眼压，减轻患者眼部疼痛症状，并具有良好的安全性。

Abstract:

AIM: To evaluate clinical efficacy and safety of ultrasound cycloplasty(UCP)in the treatment of refractory glaucoma.

METHODS:From June 2021 to October 2022, a total of 17 patients(17 eyes)with refractory glaucoma were enrolled in this prospective study, and they all underwent UCP. The patients underwent 6 mo followed-up post-treatment, and the intraocular pressure(IOP), pain grade score, IOP lowering drugs, success rate and occurrence of complications were documented.

RESULTS:The IOP was significantly decreased from 51.98±7.80 mmHg before UCP to 32.54±13.21 mmHg at 1 d, 22.38±11.98 mmHg at 1 wk, 22.63±10.78 mmHg at 1 mo, 26.05±9.17 mmHg at 3 mo, and 23.73±9.60 mmHg at 6 mo postoperatively(all P<0.01). The percentage of IOP reduction after treatment was 36.25%, 57.10%, 56.35%, 49.16% and 54.09% at 1 d, 1 wk, 1, 3, and 6 mo, respectively. The pain grade scores were decreased(P<0.01). There was a statistically significant reduction in the use of IOP lowering medications(P=0.008). At 6 mo postoperatively, 2 eyes(12%)were complete success, 11 eyes(65%)were qualified success, and 4 eyes(24%)were failure. The main complication observed was anterior chamber inflammation in 1 eye(6%), foreign body sensation in 2 eyes(12%), subconjunctival hemorrhage in 2 eyes(12%), and conjunctival congestion in 6 eyes(35%). All symptoms spontaneously resolved within 1 wk without requiring any specific treatment. One case of choroidal detachment(6%)occurred on 10 d postoperatively, but recovered after orally treated by prednisone acetate for 1 mo. No other serious complications, such as hyphema, corectopia, synechia or macular edema were reported.

CONCLUSION:UCP is safe and efficacious in treating refractory glaucoma, reducing IOP and alleviating ocular pain symptoms, while maintaining a favorable safety profile.