选择性激光小梁成形术治疗糖皮质激素性青光眼的疗效观察

摘要

背景 糖皮质激素在眼科治疗过程中的应用日益广泛,而糖皮质激素的局部长期应用存在诱发青光眼的潜在危险.近年来的研究表明,选择性激光小梁成形术(SLT)可用于糖皮质激素性青光眼的治疗,但其疗效需要进一步评价. 目的 观察SLT治疗糖皮质激素性青光眼的降眼压效果. 方法 采用回顾性系列病例分析设计,对经复旦大学眼耳鼻喉科医院眼科确诊的糖皮质激素性青光眼患者9例9眼行360°SLT治疗,年龄25～ 52岁.其中5例5眼为准分子激光角膜原位磨镶术(LASIK)术后长期(4～6周)使用糖皮质激素滴眼液所致,4例4眼因视网膜中央静脉阻塞(CRVO)黄斑水肿接受玻璃体腔内注射0.1 ml曲安奈德(4.O mg)所致.在接受SLT治疗前,虽然所有患者均无青光眼和高眼压病史,但这些患者使用糖皮质激素后出现了高眼压,所以均接受了最大可耐受剂量的降眼压治疗.所有患者行SLT治疗前停止使用糖皮质激素2 ～12个月,术前眼压为35 ～44 mmHg(1 mmHg=0.133 kPa).患者随访6个月,观察术眼治疗前及治疗后不同时间点的眼压变化.采用重复测量方差分析法分析治疗后各时间点术眼眼压的差异. 结果 所有患者均只接受1次SLT治疗.SLT治疗前患者的平均眼压为(40.0±2.9)mmHg,治疗后1h、1周及1、3、6个月的眼压分别为(37.9±8.1)、(34.9±5.9)、(27.6±6.7)、(21.6±6.9)和(17.9±2.9) mmHg.治疗后1、3、6个月时的平均眼压均较术前明显下降,差异均有统计学意义(P＜0.05).本组患者中2例2眼因眼压控制不良分别于SLT治疗后1个月和3个月接受了滤过性手术,SLT治疗后6个月,1例患者仍然需要使用2种局部降眼压药物控制眼压,6例患者无需使用降眼压药物.结论 在纳入的9眼中,SLT有效降低了6眼糖皮质激素性青光眼患眼的眼压,降眼压疗效出现于治疗后1个月,随访期内眼压保持稳定.%Background Glucocorticoid drugs have been used increasingly in ophthalmology.It has been established that glucocorticoid are associated with a rise in intraocular pressure (IOP) and the development of glaucoma.Selective laser trabeculoplasty (SLT) is thought to be effective in treating patients with glucocorticoidinduced elevated IOP.Objective This study was to assess the efficacy of SLT in lowering IOP in patients with glucocorticoid-induced ocular hypertension.Methods A retrospective case series study was adopted.SLT around 360° chamber angle was performed in 9 eyes of 9 patients with glucocorticoid-induced glaucoma in Eye & ENT Hospital of Fudan University,including 5 eyes of 5 patients owing to use of glucocorticoid eye drops for long-term after laser in situ keratomileusis (LASIK) and 4 eyes of 4 patients who received intravitreal injection of 0.1 ml triamcinolone acetonide (TA) (4.0 mg) for macular edema induced by central retinal vein occlusion(CRVO).All of the patients were lack of preexisting glaucoma or ocular hypertension and underwent unsuccessful maximum tolerated medical therapy before SLT treatment.The base IOP was 35-44 mmHg and glucocorticoid drugs were ceased for 2-12 months prior to the SLT.The patients were followed-up for 6 months.IOP was measured and recorded before and 1 hour,1 week,1 month and 3 months,6 months after SLT.The difference of IOP was compared by repeated measures analysis of variance and multiple comparison analysis.Results All the patients received single SLT operation.The mean IOP was (40.0±2.9) mmHg before operation,but the IOP was (37.9±8.1),(34.9±5.9),(27.6±6.7),(21.6±6.9) and (17.9±2.9)mmHg 1 hour,1 week,1 month,3 months and 6 months after SLT.The IOP at 1 month,3 months and 6 months after SLT were significantly lower than that before operation (all at P＜0.05).Two patients received a filtration surgery for uncontrolled IOP at 1 month and 3 months after SLT respectively,and another patient still used 2 kinds of lowing-IOP eye drops until the end of following-up duration.Conclusions SLT reduce IOP in 6 eyes of 9 patients with glucocorticoid-induced increased IOP from the initial 1 month through 6 months after SLT.