- 學位論文
使用選擇性雷射小樑網整型術治療原發性隅角開放性青光眼之成效
The effect of adjuvant selective laser trabeculoplasty in the treatment of primary open-angle glaucoma
摘要
研究目的：本研究目的在觀察對於原發性隅角開放性青光眼之病患，使用選擇性雷射小樑網整型術治療，對於眼壓降低的效果。 研究方法：本研究分析42個雙側原發性隅角開放性青光眼之病人，在不停用目前青光眼藥水的前提下，於2010年至2015年間其中一側眼接受180度或270度選擇性雷射小樑網整型術，另一側眼則沒有接受雷射治療。記錄並分析雷射前及雷射後兩周、一個月、三個月、六個月及十二個月雙眼之眼壓變化。 研究結果：雷射治療前，兩組眼睛 (有接受雷射及沒有接受雷射) 的眼壓並沒有差異。有接受雷射治療的眼睛在雷射後兩周眼壓有稍微上升但未達統計學差異；然而，在雷射治療後一個月、三個月、六個月、十二個月眼壓均較雷射前降低且達統計學差異。沒有接受雷射治療的眼睛之眼壓則在每個統計時間點均沒有差異。再比較兩組眼睛，發現有接受雷射治療的眼睛在雷射後一個月至一年間都比沒有接受雷射的眼睛有更低的眼壓。 結論：對於已使用藥物治療之原發性隅角開放性青光眼患者，使用選擇性雷射小樑網整型術可以更進一度降低眼壓，對於減緩青光眼惡化有其治療角色。雖然剛打完雷射會有短暫眼壓上升之現象，但通常會自行恢復。總結來說，對於隅角開放性青光眼患者，選擇性雷射小樑網整型術是一個安全且有效降低眼壓的新治療方法。
並列摘要
Purpose: To evaluate the efficacy of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) for the treatment of primary open angle glaucoma. Methods: Forty-two subjects with bilateral medically treated primary open-angle glaucoma (POAG) were included. All patients underwent adjuvant 180 or 270 degrees of SLT on only one eye between 2010 and 2015 and continued the current medication. Intraocular pressure (IOP) of both eyes was measured before and 2 weeks, and 1, 3, 6, and 12 months after SLT. Results: Before SLT, there was no significant difference between the mean IOP of both eyes ( 15.4± 2.6 mmHg vs 15.2 ± 2.5 mmHg, P=0.22 ), and good correlation of pre-SLT IOP in both eyes was observed. After SLT, IOP increased mildly to 16.3 ± 2.7 mmHg by the first two weeks ( P=0.53 ) in the SLT eye. However, mean IOP in the SLT eye decreased to 12.5 ± 2.9 mmHg at 1 month ( P ≤ 0.001). There was sustained and statistically significant ( P< 0.001 ) decrease in IOP in that eye at 3,6 and 12 months. In contrast, the IOP in the fellow eye ( non-SLT) remained unchanged. Postoperative inflammatory reaction was scanty. Conclusion: There is sustained decrease in IOP after SLT in POAG eyes. 180 or 270 degrees of SLT is effective and safe supplemental treatment for patients with medically treated POAG in furtherly lowering IOP. Transient IOP spikes usually resolve quickly with or without anti-glaucoma treatment. The effect of IOP decrease after SLT is unilateral and does not affect the fellow eye.