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目的 :观察接触性二极管睫状体光凝术治疗穿透性角膜移植术后难治性青光眼的效果和对角膜植片的影响。方法 :使用IRIS OculightSLX二极管激光系统 ,光凝角巩膜缘外 1 2mm处 ,范围 180°～ 36 0° ,能量 1 7～ 2 6W ,2 0～ 4 0点 ,对 2 4例穿透性角膜移植术后难治性青光眼患者共 2 4只眼行 1～ 3次半导体二极管睫状体光凝术 ,随访时间≥ 9个月者被列入本研究。结果 :眼压 :治疗前在用抗青光眼药物的情况下眼压为 (32± 9 7)mmHg(2 7～ 5 9mmHg)。激光治疗后一周内眼压明显降低 ,随访 9～ 16个月 (平均 11 4个月 ) ,末次随访眼压为 (18± 5 8)mmHg(8～ 2 8mmHg) ,眼压平均降低 14mmHg。视力 :末次随访视力从 0 2到手动 ,手术后视力无改变者 16只眼 (6 6 7% ) ,下降者 6只眼 (2 5 % ) ,提高者 2只眼 (8 2 % )。角膜植片 :术前植片透明者 16只眼 ,半透明 2只眼 ,混浊 6只眼 ,术前植片透明眼在术后有 3只眼 (19% )发生排斥反应致植片混浊 ,排斥均发生在术后 3个月内 ,术前植片半透明的 2只眼在术后植片亦变混浊。结论 :接触性二极管睫状体光凝术简单易行 ,安全有效 ,可重复进行。对于多次行其它抗青光眼手术治疗 ,眼压不能控制的穿透性角膜移植术后难治性青光眼 ,是一个较好的选择。
Objective: To observe the effect of contact diode ciliary body photocoagulation on refractory glaucoma after penetrating keratoplasty and its effect on corneal graft. Methods: The IRIS Oculight SLX diode laser system was used. The photocoagulation angle was 120 mm outside the scleral edge, 180 ° ~ 36 0 °, and the energy was 17 ~ 26 W and 20 ~ 40 points. Twenty-four cases of penetrating keratoplasty A total of 24 patients with refractory glaucoma underwent one to three times diode photocoagulation of ciliary body during the follow-up period of ≥ 9 months. RESULTS: Intraocular pressure: IOP was (32 ± 9 7) mmHg (27 to 59 mmHg) with anti-glaucoma medication before treatment. Intraocular pressure was significantly reduced in one week after laser treatment. The follow-up ranged from 9 to 16 months (average 11 4 months). The intraocular pressure at the final follow-up was (18 ± 58) mmHg (8 to 28 mmHg) and the intraocular pressure was reduced by 14 mmHg on average. Visual acuity: The visual acuity of the last follow-up was from 0 2 to manual, 16 eyes (66.7%) had no change of visual acuity after operation, 6 eyes (2.5%) descended, and 2 eyes (8 2%) improved. Corneal graft: There were 16 eyes of translucent before surgery, 6 eyes of translucent, 6 eyes of opacity, 3 eyes (19% Exclusion occurred in 3 months after surgery, preoperative translucent transplanted two eyes also opacified after the operation. Conclusion: Contact diode ciliary body photocoagulation is simple, safe and effective, and can be repeated. For many other anti-glaucoma surgery, intraocular pressure can not control the penetrating keratoplasty refractory glaucoma, is a better choice.