■评估慢凝经巩膜睫状体光凝(SC-TSCPC)在主要非洲裔美国青光眼患者人群中的结局。
■在2019年11月6日至2023年9月7日之间,由一名外科医生对104例SC-TSCPC的连续病例进行了回顾性图表审查。功率范围从1150到1500mW,持续时间为4s,斑点的数量从10到25。排除标准是诊断为新生血管性青光眼,以前的CPC,视敏度(VA)没有光的感知或无法评估由于患者的精神状态,无晶状体,或随访<3个月。主要结局指标是手术成功率,定义为6-21mmHg的眼内压(IOP)与基线降低≥20%。无青光眼再手术,不会失去光的知觉。次要结果指标包括VA,青光眼药物使用,和术后并发症。分析也通过晶状体状态分层,因为文献表明CPC后假晶状体眼的IOP降低效果更大。
■有28例符合条件的患者(6例,22假晶状体)包括在此分析中。平均随访11.6±8.3个月,14例患者的术后1年数据可用。平均年龄75.2±13.9岁,42.9%是女性,92.9%是非洲裔美国人,反映当地社区的人口结构。1年的累积成功率为68.5%,有晶状体和假晶状体患者之间没有显着差异。平均VA从术前的20/600恶化到最后一次随访时的20/1050(P=0.04),并且在有晶状体组中稍差(P=0.15)。平均眼压从术前使用4.0±1.5药物的31.1±13.2mmHg下降到末次随访时使用2.6±1.5药物的13.8±7.1mmHg(P<0.001;P<0.01),在假晶状体患者中效果更明显。85.7%的患者前房(AC)炎症延长超过1个月,在最后一次随访时,这一比例为10.7%。黄斑囊样水肿(CME)率为21.4%,最后一次随访时持续10.7%。
■SC-TSCPC是一种有效的,有晶状体眼和假晶状体眼的非切口眼压降低手术可能不是切口性青光眼手术的理想选择。假性晶状体眼可能会经历更大的IOP降低,然而,激光设置可根据患者个体目标进行逐案滴定。与报告发生率为12.7%和2.7%的类似研究相比,我们队列中长期AC炎症和CME的发生率更高。分别。尽管这些并发症的重要性可能因每个患者的视觉潜力而有所不同,这些发现支持了现有文献中的非裔美国患者在眼科手术后的炎症和随后的后遗症发生率更高.
UNASSIGNED: To evaluate outcomes of slow coagulation transscleral cyclophotocoagulation (SC-TSCPC) in a primarily African American patient population with glaucoma.
UNASSIGNED: A retrospective chart review was performed for 104 consecutive cases of SC-TSCPC by a single surgeon between November 6, 2019-September 7, 2023. Power ranged from 1150 to 1500 mW, duration was 4 s, and number of spots ranged from 10 to 25. Exclusion criteria were diagnosis of neovascular glaucoma, prior CPC, visual acuity (VA) of no light perception or unable to be assessed due to patient\'s mental status, aphakia, or follow-up <3 months. The primary outcome measure was surgical success defined as an intraocular pressure (IOP) of 6-21 mmHg with a ≥20 % reduction from baseline, no glaucoma re-operation, and no loss of light-perception. Secondary outcome measures included VA, glaucoma medication use, and post-surgical complications. Analysis was also stratified by lens status as literature suggests a greater IOP-lowering effect in pseudophakic eyes after CPC.
UNASSIGNED: There were 28 eligible patients (6 phakic, 22 pseudophakic) included in this analysis. Mean follow-up was 11.6 ± 8.3 months, and 14 patients had postoperative year 1 data available. The mean age was 75.2 ± 13.9 years, 42.9 % were female, and 92.9 % were African American, reflective of the demographics of the local community. The cumulative success rate was 68.5 % at 1 year and did not differ significantly between phakic and pseudophakic patients. Mean VA worsened from 20/600 preoperatively to 20/1050 at last follow-up (P = 0.04) and was marginally worse in the phakic group (P = 0.15). Mean IOP decreased from 31.1 ± 13.2 mmHg on 4.0 ± 1.5 medications preoperatively to 13.8 ± 7.1 mmHg on 2.6 ± 1.5 medications at last follow-up (P < 0.001; P < 0.01), with a more pronounced effect among pseudophakic patients. 85.7 % of patients had prolonged anterior chamber (AC) inflammation beyond 1 month, which persisted in 10.7 % at last follow-up. The cystoid macular edema (CME) rate was 21.4 %, with 10.7 % persistent at last follow-up.
UNASSIGNED: SC-TSCPC is an effective, non-incisional IOP-lowering procedure in phakic and pseudophakic eyes that may not otherwise be ideal candidates for incisional glaucoma surgery. Pseudophakic eyes may experience larger reductions in IOP, however, laser settings can be titrated on a case-by-case basis depending on individual patients\' goals. There was a higher incidence of prolonged AC inflammation and CME in our cohort compared to similar studies which report rates of 12.7 % and 2.7 %, respectively. Although the significance of such complications may differ based on the visual potential of each patient, these findings support existing literature that African American patients can have greater incidence of inflammation and subsequent sequalae after ocular surgery.