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目的通过观察二极管激光睫状体光凝术后的眼球病理改变来进一步研究二极管激光睫状体光凝术的降眼压机制,指导临床。方法我院于2003年1月开始应用二极管激光睫状体光凝术治疗难治性青光眼和晚期青光眼,至2004年12月共治疗115例,因初期治疗能量和击射点数不足,致4位患者未能达到预期疗效,患者惧怕二次手术而要求行眼球摘除术,1位患者因角膜内皮功能失代偿继发角膜感染而行眼球摘除术,获得病理资料。5例患者术前均为新生血管性青光眼绝对期,眼球摘除距二极管激光睫状体光凝术时间分别为20d、1m、2m、4m和1y。结果病理所见:眼球大体未见明显改变,均为新生血管性青光眼。前房内有渗出或出血,视神经萎缩,视网膜内出血,睫状体表层巩膜有充血。睫状体部位主要表现为:(1)无色素细胞的空泡变、萎缩或轻度增生;(2)色素上皮细胞破碎、分解、脱颗粒,部分色素上皮细胞萎缩;(3)睫状突基质纤维变性。在二极管激光术后早期眼球病理所见主要为睫状体色素上皮细胞色素颗粒分解游离、细胞有破碎,睫状突基质内血管变细。在术后晚期眼球病理所见主要为睫状体无色素上皮细胞萎缩,有较广泛的空泡样变性,睫状突变短、萎缩。结论二极管激光的降眼压机理是以破坏睫状上皮,睫状体萎缩,减少房水产生为主,血管损伤也有不可忽视的作用。治疗失败的原因主要是未将睫状突放在激光治疗范围内。因此二极管激光睫状体光凝术治疗难治性青光眼和晚期青光眼是安全有效的。
Objective To observe the ocular ocular pathological changes after diode laser ciliary body photocoagulation to further study the mechanism of ocular laser ciliary body photocoagulation to reduce the intraocular pressure and guide the clinical practice. Methods In our hospital from January 2003, the application of diode laser ciliary body photocoagulation for the treatment of refractory glaucoma and late glaucoma, to December 2004 a total of 115 cases of treatment, due to the initial treatment of energy and the lack of points, causing 4 Patients failed to achieve the desired effect, patients were afraid of the second surgery requiring eye surgery, a patient with corneal endothelial dysfunction due to corneal infection and enucleation of the eye, access to pathological data. All 5 patients underwent neovascular glaucoma surgery before surgery. The removal time of laser ciliary body photocoagulation was 20d, 1m, 2m, 4m and 1y respectively. Results Pathology seen: no significant change in the eye generally are neovascular glaucoma. Exudate or bleeding in the anterior chamber, optic atrophy, retinal hemorrhage, ciliary body surface scleral congestion. Ciliary body parts mainly as follows: (1) no vacuolar cell vacuoles, atrophy or mild hyperplasia; (2) pigment epithelial cells broken, decomposed, degranulation, a part of pigment epithelial cells atrophy; (3) ciliary processes Matrix fibrosis. In the early post-diode laser eye pathology seen mainly ciliary body pigment epithelial cells pigment dissociation free, broken cells, ciliary processes within the stromal vascular thinning. In the late postoperative pathology seen mainly ciliary body atrophy of achondroplasia, a more extensive vacuolar degeneration, short ciliary shortening, atrophy. Conclusion The mechanism of intraocular pressure drop of diode laser is based on the destruction of ciliary epithelium, ciliary body atrophy, reduce the production of aqueous humor, vascular injury can not be ignored. The main reason for the failure of treatment is the ciliary process in the scope of laser treatment. Therefore, diode laser ciliary body photocoagulation for the treatment of refractory glaucoma and advanced glaucoma is safe and effective.