选择性激光小梁成形术:青光眼治疗的新选择

摘要

The management of open-angle glaucoma is a long-term,even lifelong procedure.A right medical decision can gain better efficacy and economic benefit and effectively avoid medical risk.Selective laser trabeculoplasty (SLT) is a therapy approved by FDA of USA and has been applied in China over decade.However,the clinical efficacy assessment is still controversial in China.For re-evaluation of the indication,methodology,technical parameters,and the efficacy of SLT will give full play to its advantage of the potential sufficient control of intraocular pressure (IOP) in glaucomatous treatment.The development of history,mechanism and effectiveness in control IOP,security and operation of SLT are reviewed.The suitable population,technique parameters,multiple centers clinical trial and the cost-effectiveness of SLT for Chinese glaucomatous patients are also proposed.%开角型青光眼的治疗是一个长期的过程,临床医师正确的治疗决策对于患者获得更好的疗效和经济效益比,有效规避治疗风险有着重要的临床意义和社会意义.选择性激光小梁成形术(SLT)是由美国FDA批准应用于临床的治疗技术,引入中国已有十余年的历史,但多年来国内对其疗效的评价始终存在争议,且中国报道的疗效明显不如西方国家.重新考察SLT在中国的适应证、技术方法和参数选择方面的应用规范,重新认识和评价SLT对中国开角型青光眼的治疗效果将充分发挥其在青光眼综合性治疗手段中应有的作用.就SLT的发展沿革、可能的降眼压作用机制、治疗有效性和安全性、操作的简便性以及其在中国青光眼人群中施行的病例选择、技术参数探索和多中心临床研究方向、疗效和经济效益比等提出分析和评价建议.