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青光眼手术治疗方法已被分为睫状体破坏性(减少流入)或滤过性(增加流出)两大类。睫状体破坏性手术传统上用于视力预后差的青光眼以及难治性青光眼如外伤后、无晶状体眼、先天性青光眼和发育性青光眼。自从1992年Uram首次使用内窥镜下睫状体光凝术(endoscopic cyclo-photocoagulation,ECP)以来,短期和长期的转归已经表明ECP的应用前景广阔。本文在PubMed查询、复习有关ECP的英文文献,并与新加坡一所眼科三级医院的有限结果进行比较。文献报告显示出ECP及联合白内障超声乳化术的ECP在治疗小儿及成人严重的、各种病因所致的青光眼方面的安全性和有效性。这在新加坡某眼科三级医院未发表的短期结果中也有报告,与那些已经发表的结果是一致的。已发表的报告和当前的经验证明,可直视目标组织的ECP,通过内窥镜直视将合适的红外波长激光能量应用于目标组织睫状上皮细胞,避免了“盲目”状态下经巩膜睫状体光凝术所引起的并发症。但是引进这项技术存在着显著的经费困难。ECP在控制眼压和减少抗青光眼药物的依赖性方面是安全有效的。广泛接受和使用这一技术仍有待于大规模的随机对照研究。
Glaucoma surgery has been divided into ciliary body destructive (to reduce inflow) or filtration (increased outflow) two broad categories. Ciliary body destructive surgery has traditionally been used for glaucoma with poor vision outcomes as well as refractory glaucoma such as trauma, aphakia, congenital glaucoma and developmental glaucoma. Short-term and long-term outcomes have shown the promise of ECP since Uram first used endoscopic cyclo-photocoagulation (ECP) in 1992. This article reviews the PubMed inquiries, reviews the English literature on ECP, and compares it to the limited results at an Ophthalmology tertiary level hospital in Singapore. Literature reports show that ECP and cataract phacoemulsification in the treatment of ECP in children and adults with severe, all causes of glaucoma in the safety and effectiveness. This is also reported in the unpublished short-term outcome of a tertiary ophthalmology hospital in Singapore, which is consistent with those already published. Published reports and current experience demonstrate that direct viewing of the ECP of the target tissue and directing suitable infrared wavelength laser energy to the target tissue ciliary epithelium by endoscopy can avoid “blind” Scleral ciliary body photocoagulation caused by complications. However, there are significant financial difficulties in introducing this technology. ECP is safe and effective in controlling intraocular pressure and reducing dependence on anti-glaucoma medications. The widespread acceptance and use of this technology remains to be seen in large-scale randomized controlled studies.