微脉冲经巩膜激光治疗难治性青光眼有效性及安全性评估：前瞻性多中心观察研究

林凤彬; 胡白玉; 凌绮莹; 宋云河; 高新博; 张英哲; 陈瑜; 段宣初; 曾流芝; 张秀兰

doi:10.3760/cma.j.cn115989-20231201-00192

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中华实验眼科杂志

• 临床研究 •

ENGLISH ABSTRACT

微脉冲经巩膜激光治疗难治性青光眼有效性及安全性评估：前瞻性多中心观察研究

作者及单位信息

出版日期： 2024 -06 -10 ·

DOI： 10.3760/cma.j.cn115989-20231201-00192

Efficacy and safety of micropulse transscleral cyclophotocoagulation in the treatment of refractory glaucoma: a prospective multicenter observational study

Authors Info & Affiliations

Lin Fengbin

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China

Hu Baiyu

Chengdu First People's Hospital (Chengdu Integrated TCM&Western Medicine Hospital), Chengdu 610095, China

Ling Qiying

Changsha Aier Eye Hospital, Changsha 410029, China

Song Yunhe

Gao Xinbo

Zhang Yingzhe

Chen Yu

Duan Xuanchu

Changsha Aier Eye Hospital, Changsha 410029, China

Zeng Liuzhi

Chengdu First People's Hospital (Chengdu Integrated TCM&Western Medicine Hospital), Chengdu 610095, China

Zhang Xiulan

Published： 2024 -06 -10 ·

DOI： 10.3760/cma.j.cn115989-20231201-00192

780

118

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摘要

目的评估微脉冲经巩膜激光(MP-TSCPC)治疗难治性青光眼的有效性及安全性。

方法采用前瞻性多中心系列病例观察研究，对2022年8月至2023年4月在中山大学中山眼科中心、成都市第一人民医院(成都市中西医结合医院)和长沙爱尔眼科医院拟行MP-TSCPC治疗的难治性青光眼患者63例67眼，其中抗青光眼术后眼压未降40眼(占59.7%)，玻璃体切割术后继发性青光眼4眼(占6.0%)，角膜移植术后继发性青光眼2眼(占3.0%)，新生血管性青光眼8眼(占11.9%)，虹膜角膜内皮综合征继发性青光眼3眼(占4.5%)，原发性开角型青光眼6眼(占9.0%)，原发性闭角型青光眼4眼(占6.0%)。采用ETDRS视力表及Goldmann压平眼压计分别测量患者术前和术后6个月内最佳矫正视力(BCVA)及眼压。记录患者术前和术后抗青光眼药物使用情况及术后并发症发生情况。计算手术成功率，手术成功定义为末次眼压较基线降低>20%或眼压不变但使用的抗青光眼药物减少。

结果手术前后不同时间点眼压总体比较差异有统计学意义( F＝60.10， P<0.001)，其中术后不同时间点眼压均明显低于术前，差异均有统计学意义(均 P<0.001)。术后6个月眼压降幅为(43.7±20.7)%。术后使用抗青光眼药物数量为2(0，3)种，较术前的3(2，3)种明显减少，差异有统计学意义( Z＝－2.70， P＝0.007)。术眼术后6个月BCVA(LogMAR视力)为1.40(0.52，2.70)，较术前的1.40(0.70，2.70)无明显变化，差异无统计学意义( Z＝－0.10， P＝0.952)。术后6个月手术成功率为83.6%(56/67)。手术并发症主要包括瞳孔扩大(11/67)、结膜出血(11/67)、轻微前房炎症(1/67)、轻度睫状体脱离(3/67)、局部脉络膜脱离(1/67)和黄斑囊样水肿(1/67)，均在药物治疗后好转。

结论MP-TSCPC是治疗难治性青光眼安全、有效的方法。

关键词：难治性青光眼;手术;多中心研究;微脉冲经巩膜激光治疗;有效性;安全性

ABSTRACT

ObjectiveTo evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) for refractory glaucoma.

MethodsA prospective multicenter observational case series study was conducted.A total of 63 refractory glaucoma patients (67 eyes) who underwent MP-TSCPC treatment were enrolled at Zhongshan Ophthalmic Center, Sun Yat-sen University, Chengdu First People's Hospital (Chengdu Integrated TCM& Western Medicine Hospital), and Changsha Aier Eye Hospital from August 2022 to April 2023.Among these cases, there were 40 eyes (59.7%) with unreduced intraocular pressure (IOP) after glaucoma surgery, 4 eyes (6.0%) with secondary glaucoma after vitrectomy, 2 eyes (3.0%) with secondary glaucoma after keratoplasty, 8 eyes (11.9%) with neovascular glaucoma, 3 eyes (4.5%) with secondary glaucoma due to iridocorneal endothelial syndrome, 6 eyes (9.0%) with primary open-angle glaucoma and 4 eyes (6.0%) with primary angle-closure glaucoma.Best corrected visual acuity (BCVA) was measured using the ETDRS chart and the IOP was measured using the Goldmann applanation tonometry before and 6 months after the surgery.The usage of anti-glaucoma medications before and after surgery and postoperative complications were recorded.Surgical success rate was calculated and surgical success was defined as an IOP reduction of more than 20% from baseline or a reduction in the number of ocular hypotensive medications with no change in IOP.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2022KYPJ225).Written informed consent was obtained from each subject.

ResultsThere was a statistically significant overall difference in IOP at different time points before and after surgery ( F=60.10, P<0.001), and the IOP at different time points after surgery was significantly lower than that before surgery, with statistically significant differences (all at P<0.001).IOP reduction at 6 months after surgery was (43.7±20.7)%.The number of anti-glaucoma medications used postoperatively was 2(0, 3) types, which was significantly less than the 3(2, 3) types used preoperatively ( Z=-2.70, P=0.007).The 6-month postoperative BCVA (LogMAR) was 1.40(0.52, 2.70), which showed no significant change compared to the preoperative 1.40(0.70, 2.70) ( Z=-0.10, P=0.952).The surgical success rate was 83.6%(56/67) at 6 months postoperatively.Postoperative complications included mydriasis (11/67), conjunctival hemorrhage (11/67), mild anterior chamber inflammation (1/67), mild ciliary body detachment (3/67), local choroidal detachment (1/67), and cystoid macular edema (1/67), all of which were reversible after treatment.

ConclusionsMP-TSCPC appears to be a safe and effective treatment option for refractory glaucoma.

KEYWORDS： Glaucoma, refractory;Surgery;Multicenter study;Micropulse transscleral cyclophotocoagulation;Effectiveness;Safety

Corresponding authors: Zhang Xiulan, Email: nc.defudabe.usys.liam2lxgnahz;

Corresponding author:Zeng Liuzhi, Email: mocdef.qabq169186676;

Corresponding author:Duan Xuanchu, Email: nc.defudabe.uscuhcxnaud

NOTES:

Lin Fengbin, Hu Baiyu and Ling Qiying contributed equally to this article

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

林凤彬,胡白玉,凌绮莹,等. 微脉冲经巩膜激光治疗难治性青光眼有效性及安全性评估：前瞻性多中心观察研究[J]. 中华实验眼科杂志,2024,42(06)：527-531.

DOI:10.3760/cma.j.cn115989-20231201-00192

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青光眼是全球主要的不可逆性致盲眼病，据估计到2040年，全球将有超过1.118亿青光眼患者 ^{[
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3
]}。降眼压治疗是目前唯一被证实可有效控制青光眼进展、保护视功能的方法，目前的降眼压方法主要包括药物、激光和手术三大类 ^{[
4
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6
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]}，但其术后反应重，且并发症较多，如持续性低眼压、眼内炎、视力下降、玻璃体积血及眼球萎缩等 ^{[
8
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]}。微脉冲经巩膜激光治疗(micropulse transscleral cyclophotocoagulation，MP-TSCPC)是一种新型非侵入式且可重复的微创青光眼治疗方式，通过微脉冲激光透过巩膜对睫状体产生非致命性的破坏，达到降低眼压的作用，适用于各种轻度到重度原发性开角型青光眼(primary open-angle glaucoma，POAG)、原发性闭角型青光眼(primary angle-closure glaucoma，PACG)和难治性青光眼的治疗 ^{[
10
,

11
]}。文献报道MP-TSCPC治疗难治性青光眼成功率高，同时其并发症发生率低，常见的并发症主要包括瞳孔扩大、少数的轻微前房炎症、低眼压和结膜出血，是一种安全、有效的抗青光眼手术方式 ^{[
12
,

13
,

14
,

15
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16
,

17
]}。但在我国，MP-TSCPC开展实践时间较短，其有效性和安全性仍缺乏长期的观察和评估。本研究拟通过多中心前瞻性观察研究，评估MP-TSCPC治疗难治性青光眼患者的有效性和安全性，以期为我国难治性青光眼患者手术方案的选择提供参考依据。

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参考文献

参考文献

[1]

GBD 2019 Blindness and Vision Impairment Collaborators，Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years，and prevalence of avoidable blindness in relation to VISION 2020：the Right to Sight：an analysis for the Global Burden of Disease Study[J/OL]. Lancet Glob Health， 2021，9(2)∶e144－e160[2023－11－10]. https://pubmed.ncbi.nlm.nih.gov/33275949/. DOI： 10.1016/S2214-109X(20)30489-7 .