Background Selective laser trabeculoplasty (SLT) is one of common therapies for early-stage primary open angle glaucoma (POAG).However,it always been used as a method of treating medically uncontrolled open angle glaucoma in China.So the assessment of efficacy of SLT as the initial therapy for POAG is still lack.Objective This clinical study was to compare the efficacy of SLT in early-stage POAG eyes with or without primary medical therapy.Methods A prospective non-randomized controlled study was designed.Sixty-five eyes of 37 patients with early-stage POAG were divided into without pre-treated group (30 eyes of 16 patients) and with pretreated group (35 eyes of 21 patients).SLT was performed on the inferior trabecular meshwork of 180° in all the patients aged 12-57 years old using a 532 nm frequency-doubled,Q-switched Nd:YAG laser with the pulse 3 ns,spot diameter 400 μm.The emitting energy was set from an initial energy of 0.6 mJ to decreased energy successively at 0.1 mJ interval till bubbles coming out.The following-up was 6 months.Primary outcome of SLT included the changes of intraocular pressure (IOP) and effective rate,and the secondary outcome included the perimetry and C/D value.The safety index was evaluated as the incidence of irritative symptom.Results After SLT 1 day to 6 months,the IOP was lower than that before SLT in all the patients (all at P＜0.05).The IOP was (24.03± 3.76)mmHg and (19.18±3.86)mmHg respectively at preoperation and postoperative 1 month in without pretreated group,with a mean decreasing value of (4.85 ±4.31)mmHg,in with pretreated group,the IOP was (23.63±4.29)mmHg at preoperation and (17.07±4.15)mmHg at postoperative 1 month,with a mean difference of (6.28±3.57)mmHg,with a significant difference in the IOP lowing value between the two groups (P =0.045),but there were no significant differences in the IOP lowing value between without and with pretreated groups in 1 hour,1 day,3 months and 6 months after SLT (all at P＞0.05).The effective rate was 75.00％ and 76.67％ in without and with pretreated groups respectively at the end of following-up (P =0.882).No obvious changes were seen in visual field and C/D value before and after SLT in both groups.Also,no serious complication was found in the patients during the following-up duration.Conclusions SLT has a good outcome in lowing-IOP for early stage POAG.There is no obvious impact to the clinical efficacy of SLT whether with or without the primary administration of anti-glaucomatous eye drops.Long-term effect of SLT remains to be observed.%背景 选择性激光小梁成形术(SLT)是治疗早期原发性开角型青光眼(POAG)常用的方法之一,但其在中国多被用于抗青光眼药物控制眼压效果欠佳的开角型青光眼患者,目前中国尚无SLT作为POAG初始疗法的效果评价. 目的 比较SLT对未经过任何治疗和经过局部抗青光眼药物治疗而眼压未得到控制的早期POAG患者的疗效和安全性.方法 本研究为前瞻性临床试验,采用非随机病例对照的研究方法.按照患者行SLT前是否局部使用抗青光眼药物将纳入的早期POAG患者37例65眼分为未预治疗组16例30眼和预治疗组21例35眼,患者年龄为12 ～57岁,所有患眼均采用Seleeta duet 532 nm倍频Q开关Nd:YAG激光器行SLT,激光脉冲时间为3 ns,光斑直径为400tμm,初始能量为0.6mJ,之后以0.1 mJ为单位逐步递减,至刚好出现气泡时为治疗能量,治疗范围为下方180°小梁网.所有患者随访6个月,主要疗效指标包括眼压的变化及术后6个月的治疗成功率,次要结局指标为视功能和视杯改变.SLT的安全性评价指标为术后术眼的刺激症状发生率.结果 治疗后1d～6个月,所有患眼眼压均较术前明显下降,差异均有统计学意义(P＜0.05).未预治疗组SLT术前和术后1个月眼压分别为(24.03±3.76) mmHg(1 mmHg=0.133 kPa)和(19.18±3.86)mmHg,眼压平均下降了(4.85±4.31) mmHg,预治疗组患眼SLT术前和术后1个月眼压分别为(23.63±4.29) mmHg和(17.07±4.15) mmHg,眼压平均下降了(6.28±3.57) mmHg,两组间眼压下降幅度比较差异有统计学意义(P=0.045),但两组间在术后1h、1d、1周、3个月和6个月眼压下降值的差异均无统计学意义(P＞0.05).术后6个月未预治疗组和预治疗组的治疗成功率分别为75.00％和76.67％,差异无统计学意义(P=0.882).术后各时间点术眼视野损害及视神经检查与术前比较均无明显进展.2个组术眼术后各时间点均未发现严重并发症.结论 SLT对早期POAG患者具有较好的疗效和安全性,术前是否局部应用抗青光眼药物对SLT的短期降眼压效果无明显影响,但SLT的长期疗效有待进一步观察.
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