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中华眼科医学杂志(电子版) ›› 2019, Vol. 09 ›› Issue (06) : 366 -371. doi: 10.3877/cma.j.issn.2095-2007.2019.06.008

论著

超声睫状体成形术治疗难治性青光眼半年随访效果的临床研究
牟大鹏1, 唐炘1,†(), 安文在1, 李蕾1, 卿国平1, 宋彦铮1, 时毅1   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科学与视觉科学重点实验室
  • 收稿日期:2019-08-30 出版日期:2019-12-28
  • 通信作者: 唐炘
  • 基金资助:
    北京市科技重大专项(Z171100001017040)

Half-year follow-up of ultrasound cycloplasty for refractory glaucoma

Dapeng Mou1, Xin Tang1,†(), Wenzai An1, Lei Li1, Guoping Qing1, Yanzheng Song1, Yi Shi1   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Key Laboratory of Beijing Ophthalmology & Visual Sciences, Beijing 100730, China
  • Received:2019-08-30 Published:2019-12-28
  • Corresponding author: Xin Tang
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牟大鹏, 唐炘, 安文在, 李蕾, 卿国平, 宋彦铮, 时毅. 超声睫状体成形术治疗难治性青光眼半年随访效果的临床研究[J]. 中华眼科医学杂志(电子版), 2019, 09(06): 366-371.

Dapeng Mou, Xin Tang, Wenzai An, Lei Li, Guoping Qing, Yanzheng Song, Yi Shi. Half-year follow-up of ultrasound cycloplasty for refractory glaucoma[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2019, 09(06): 366-371.

目的

探讨超声睫状体成形术(UCP)治疗难治性青光眼的有效性及安全性。

方法

收集首都医科大学附属北京同仁医院眼科中心确诊的难治性青光眼患者11例(11只眼)的临床资料。其中，男性6例(6只眼)，女性5例(5只眼)，年龄28~68岁，平均年龄(48.0±20.4)岁。11例患者中1例为原发性闭角型青光眼术后眼压失控，5例为玻璃体切除术后或其它疾病引起的继发性青光眼，3例为新生血管性青光眼，2例为原发性开角型青光眼术后眼压失控。所有患者术前均经最佳矫正视力检查、裂隙灯显微镜眼底检查、眼压测量、光学生物测量及超声生物显微镜检查。行UCP术后，以平均眼压降低幅度和6个月后的手术成功率来评估UCP治疗的有效性。数据以平均值±标准差(±s)表示。数据缺失时，采用混合效应模型比较不同时间点的眼压变化；采用Wilcoxon检验比较术前与术后降眼压药物使用数量的变化；采用线性回归分析比较术前及其与术后眼压降低差值的关系。

结果

11例患者(11只眼)全部接受UCP手术治疗，术后3个月的手术成功率为54%(6/11)，术后6个月的手术成功率为36%(4/11)。术前、术后7 d、3个月及6个月的平均眼压分别为(40.82±3.47)mmHg(1 mmHg＝0.133 kPa)、(20.26± 3.43)mmHg、(19.89± 4.35)mmHg及(22.06±5.15)mmHg。与术前比较，差异均有统计学意义(t＝-4.23，-3.80，-3.05；P<0.05)。术后6个月，每日降眼压药的使用数量明显降低，平均降压药物由(3.09±0.3)种降至(2.3±0.2)种，且两者差异有统计学意义(Z＝7.27，P<0.05)。

结论

UCP术后6个月能有效地降低眼压，但其术后效果的长期评价仍需观察。

关键词: 超声睫状体成形术, 高强度聚焦超声, 难治性青光眼, 眼压
Objective

The aim of this study was to evaluate the efficacy and safety of ultrasound cycloplasty (UCP) in the treatment of refractory glaucoma.

Methods

11 patients (11 eyes) with refractory glaucoma diagnosed by the Beijing Tongren Eye Center of Beijing Tongren Hospital Affiliated to Capital Medical University were collected, including 6 males (6 eyes) and 5 females (5 eyes), age (28 to 68) with an average age of (48.0±20.4) years. Among of them, there were 1 case with primary angle closure glaucoma, 5 cases with secondary glaucoma caused by vitrectomy or other diseases, 3 cases with neovascular glaucoma and 2 cases with primary angle closure glaucoma. All patients′ examinations were included the best corrected vision, slit lamp biomicroscopy, fundus examination, intraocular pressure measurement, optical biometry and ultrasound biomicroscopy. After UCP, the evaluation of the efficacy was represented as the mean reduction of intraocular pressure and the success rate after 6 months. The mean±SD was used to describe the data. When the data collected during follow-up stage were missing, the mixed effect model was used to compare the changes of intraocular pressure at different time points. Wilcoxon test was used to compare the changes of using drugs to reduce intraocular pressure before and after surgery. Linear regression analysis was used to compare the difference between preoperative intraocular pressure and intraocular pressure reduction at the final follow-up.

Results

11 eyes of 11 patients were treated with UCP. The success rate was 54% (6/11) after 3 months and 36% (4/11) after 6 months. The mean intraocular pressure was (40.82±3.47) mmHg (1 mmHg=0.133 kPa) before operation and (20.26±3.43) mmHg for 7 days after operation; the mean intraocular pressure was (19.89±4.35) mmHg for 3 months after operation; the mean intraocular pressure was (22.06±5.15) mmHg for 6 months after operation. Compared with before operation, there were statistical differences (t=-3.80, -3.05, -4.23; P<0.05). At 6 months after operation, the average antihypertensive drugs decreased from 3.09±0.3 to 2.3±0.2 with statistical difference between them (Z=7.27, P<0.05).

Conclusions

After 6 month post-operation, UCP was safe and effective in reducing intraocular pressure, but its outcome is needed to determine with a longer follow-up .

Key words: Ultrasound cycloplasty, High intensity focused ultrasound, Refractory glaucoma, Intraocular pressure
图1 超声睫状体成形术患者的随访流程图
图2 不同随访时间点的眼压变化图
图3 术前、术后1个月眼压变化幅度的相关性分析
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