Офтальмохирургия. 2020; : 77-84
Эффективность и безопасность надпороговой селективной лазерной трабекулопластики как первого этапа лечения начальной стадии первичной открытоугольной глаукомы у пациентов с катарактой на фоне псевдоэксфолиативного синдрома
https://doi.org/10.25276/0235-4160-2020-2-77-84Аннотация
Надпороговая селективная лазерная трабекулопластика (СЛТ) представляет собой модификацию классической СЛТ.
Цель. Исследование клинической эффективности и безопасности надпороговой СЛТ как первого этапа комбинированного хирургического лечения начальной стадии первичной открытоугольной глаукомы у пациентов с катарактой на фоне псевдоэксфолиативного синдрома.
Материал и методы. Проведен анализ результатов первого этапа лечения в виде надпороговой СЛТ у 48 больных с начальной стадией первичной открытоугольной глаукомы (48 глаз) и катарактой на фоне псевдоэксфолиативного синдрома.
Результаты. Назначение медикаментозной терапии привело к снижению внутриглазного давления (ВГД) с 22,1±3,2 до 16,3±2,6 мм рт.ст. – на 26,3%. Через 1 мес. после надпороговой СЛТ было получено дополнительное снижение ВГД до 14,3±1,8 мм рт.ст., что составило в итоге 34,8%. Отмечалось достоверное улучшение коэффициента легкости оттока внутриглазной жидкости: с 0,12±0,03 до 0,16±0,03 мм3 / мм рт.ст.·мин. Снижение ВГД сопровождалось достоверным улучшением показателей MD и PSD по данным статической периметрии, уменьшением площади экскавации диска зрительного нерва. Колориметрический анализ показал уменьшение пигментации трабекулярной сети. Плотность эндотелиальных клеток роговицы не изменилась: ПЭК – 2204±392 кл/мм2 . Ни в одном случае не отмечено реактивной гипертензии, болезненности при пальпации в проекции цилиарного тела, преципитатов либо феномена Тиндаля.
Заключение. Надпороговая СЛТ является эффективным и безопасным методом первого этапа лечения начальной стадии первичной открытоугольной глаукомы у пациентов с катарактой на фоне псевдоэксфолиативного синдрома.
Список литературы
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11. Melamed S, Pei J, Epstein DL. Short-term effects of argon lasertrabeculoplasty in monkeys. Arch Ophthalmol. 1985;103: 1546–1552.
12. Rodrigues MM, Spaeth GL, Donohoo P. Electron microscopy of argon laser therapy in phakic openangle glaucoma. Ophthalmology. 1982;89: 198–210. doi:10.1016/s0161-6420(82)34806-x.
13. Ticho U, Zauberman H. Argon laser application to the angle structures in the glaucomas. Arch Ophthalmol. 1976;94(1): 61–64. doi:10.1001/archopht.1976.03910030023007.
14. Giaconi JA, Moore DB, Seibold LK. Laser trabeculoplasty: ALT vs SLT. American Academy of Ophthalmology. EyeWiki. 2015.
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25. Mao AJ, Pan XJ, McIlraith I, Chan JCH, Li Q, Lai J. Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension. J Glaucoma. 2008;17: 449–454. doi:10.1097/IJG.0b013e31815f52cb.
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37. Bovell AM, Damji KF, Hodge WG, Rock WJ, Buhrmann RR, Pan YI. Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty? Can J Ophthalmol. 2011;46: 408–413. doi:10.1016/j.jcjo.2011.07.016.
38. Ong K, Ong L, Ong LB. Corneal endothelial abnormalities after selective laser trabeculoplasty (SLT). J Glaucoma. 2015;24(4): 286–290. doi:10.1097/IJG.0b013e3182946381.
39. Lee JW, Chan JC, Chang RT, Singh K, Liu CC, Gangwani R, Wong MOM, Lai JSM. Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma. Eye (Lond). 2014;28(1): 47–52.
Fyodorov Journal of Ophthalmic Surgery. 2020; : 77-84
Efficiency and safety of the suprathreshold selective laser trebeculoplasty as the first stage of the early primary open-angle glaucoma treatment in patients with cateract against the background of pseudoexfoliation syndrome
https://doi.org/10.25276/0235-4160-2020-2-77-84Abstract
Suprathreshold selective laser trabeculoplasty (SLT) is a modification of the classical subthreshold SLT.
Purpose. To study the clinical efficacy and safety of suprathreshold SLT as the first stage of combined surgical treatment of the early primary open-angle glaucoma in patients with cataract against the background of pseudoexfoliation syndrome.
Material and methods. The study of 48 suprathreshold SLT cases (48 eyes) was performed in patients with early primary open-angle glaucoma (POAG) with cataract against the background of pseudoexfoliation syndrome.
Results. The drug therapy led to IOP decrease from 22.1±3.2 to 16.3±2.6 mm Hg (-26.3%). An additional IOP decrease to 14.3±1.8 mm Hg was determined 1 month after suprathreshold SLT (-34.8%). A significant improvement in the coefficient of intraocular fluid easiness outflow was noted from 0.12±0.03 to 0.16±0.03 mm3 /mm Hg·min. The decrease in IOP was accompanied by a significant improvement in MD and PSD indicators according to static perimetry and a decrease in the area of the optic disc excavation. Colorimetric analysis showed a decrease in pigmentation of the trabecular meshwork. The density of corneal endothelial cells has not changed: PEC – 2204±392 cells/mm2 . There wasn’t any clinical case of reactive hypertension, pain by palpation in the ciliary body projection, precipitates or Tyndall phenomenon during the study.
Conclusion. According to the study, suprathreshold SLT is an effective and safe method of the early primary open-angle glaucoma treatment in patients with cataract against the background of pseudoexfoliation syndrome.
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