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术前眼压可作为选择性激光小梁成形术疗效的一个预测因素

Pillunat KR, Spoerl E, Elfes G, et al.

期刊名称:Acta Ophthalmologica

卷期:2016年第94卷第7期

摘要

目的:旨在确定高,低压原发性开角型青光眼患者进行选择性激光小梁成形术(SLT)后眼内压(IOP)下降的预测因素,这些患者已经服用最大耐受量降眼压药,需要进一步的降眼压。方法:在这项前瞻性介入病例系列中,包括了157例开角型青光眼患者的157只眼,患者被安排进行SLT以进一步降低IOP。每例患者在SLT治疗前和治疗后平均6个月进行昼夜IOP测量。比较六次IOP测量的平均值。分析以下参数与SLT治疗成功之间的关联:年龄,性别,等量球镜,高压或常压开角型青光眼,降压药物数量和类型,晶状体状态,SLTIOP,诊断时IOP,青光眼持续时间,视野分期和中央角膜厚度。结果:预测SLT后绝对和相对平均昼夜眼压降低的唯一参数是术前平均昼夜眼压。百分之百的平均昼夜术前眼压超过18mmHg的患者在SLT后有IOP下降。83.1%的患者平均昼间术前值为14-18mmHg,以及64%的患者低于14mmHg显示IOP下降。这种差异具有统计学上显著性(> 1814-18相比:p = 0.002; > 18<14相比:p = 0.001相比;14-18<14相比:p =0.030)。结论: 治疗前个体IOP水平预测SLT的降眼压作用最好。治疗可能对平均昼夜IOP水平低于14mmHg的患者无益。

PURPOSE:To identify predictors of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in patients with high- and low-pressure primary open-angle glaucoma, who are already taking maximally tolerated IOP-lowering medication and need further IOP reduction.METHODS:In this prospective interventional case series, 157 eyes of 157 open-angle glaucoma patients who were assigned for SLT for further IOP reduction were included. Each patient had diurnal IOP measurements taken before and on average 6months following SLT. The mean of six IOP measurements was compared. The following parameters were analysed for their association with SLT success: age, gender, spherical equivalent, high-pressure or normal-pressure open-angle glaucoma, number and type of pressure-lowering medications, lens status, pre-SLT IOP, IOP at the time of diagnosis, duration of glaucoma, visual field stage and central corneal thickness.RESULTS:The only parameter that was predictive for absolute and relative mean diurnal IOP reduction after SLT was the preoperative mean diurnal IOP. One hundred per cent of the patients with a mean diurnal preoperative IOP of more than 18mmHg had an IOP reduction after SLT. With mean diurnal preoperative values of 14-18mmHg, 83.1% of the patients, and with values below 14mmHg only 64% of the patients, showed an IOP reduction. This difference was statistically significant (>18 compared to 14-18: p=0.002; >18 compared to <14: p=0.001; 14-18 compared to <14: p=0.030).CONCLUSIONS:The pressure-lowering effect of SLT can best be predicted by the individual IOP level before treatment. Patients with mean diurnal IOP levels below 14mmHg might not benefit from the procedure at all.


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