青光眼是世界首位不可逆性致盲性眼病,降眼压是唯一被证实有效的干预措施。手术是降低眼压的主要途径,近年来创伤更小、术后炎症反应更轻、并发症更少的微创青光眼手术逐渐在临床得到应用。超声睫状体成形术(ultrasound cycloplasty, UCP)是一种新型微创青光眼治疗技术。本文综述了国内外现有研究,表明UCP在治疗各种类型青光眼中均表现出良好的降眼压效果,但不同类型青光眼疗效存在一定差异。UCP可减少术后局部抗青光眼药物的使用数量,同时显示出较少的并发症和较轻的术后反应。与其他睫状体分泌功能减弱性手术相比,该手术在缓解难治性青光眼患者因高眼压导致的局部疼痛方面尤为有效。青光眼类型、超声探头型号匹配及治疗扇区数量是影响疗效的主要因素,其适应证的准确把握及手术参数设计的优化将进一步提高其治疗效果。本文归纳了UCP治疗青光眼的作用原理、手术操作与术后用药、适应证与禁忌证、有效性、安全性及其疗效的影响因素,以期为其临床应用和研究提供参考依据。
Glaucoma is the leading cause of irreversible blindness worldwide. Lowering intraocular pressure (IOP) is the only proven intervention to effectively prevent visual field deterioration and slow the progression of glaucoma. Surgery plays a critical role in reducing IOP, with traditional glaucoma surgeries focusing primarily on classic filtration procedures. In recent years, minimally invasive glaucoma surgeries (MIGS), characterized by less trauma, milder postoperative inflammation, and fewer complications, have been increasingly applied and continuously refined in clinical practice. Ultrasound cycloplasty (UCP) is a novel, minimally invasive technique for glaucoma treatment. This article reviews existing research both domestically and internationally, showing that UCP demonstrates good IOP-lowering effects in various types of glaucoma, though its efficacy varies across different glaucoma types. UCP reduces the need for postoperative anti-glaucoma medications, while also exhibiting fewer complications and milder postoperative reactions. Compared with other ciliary body function-reducing surgeries, UCP is particularly effective in alleviating local pain caused by elevated IOP in patients with refractory glaucoma. The type of Glaucoma, matching of the ultrasound probe model, and the number of treatment sectors are key factors influencing UCP efficacy. Accurate selection of indications and optimization of surgical parameters will further enhance its therapeutic outcomes. This article summarizes the mechanisms, surgical procedures, postoperative medication, indications and contraindications, efficacy, safety, and factors influencing UCP outcomes in glaucoma treatment, aiming to provide a reference for its clinical application and research.
目的: 观察老年性黄斑变性(Age-related macular degeneration, AMD) 和息肉状脉络膜视网膜病变(Polypoidal choroidal vasculopathy, PCV) 患者眼底陈旧性出血在吲哚青绿血管造影(Indocyanine green angiography, ICGA) 中的自发荧光表现。方法: 对伴有眼底陈旧性出血的AMD和PCV患者共 36 例(36只眼) 行ICGA检查。受试者在进行ICGA检查前, 均经过详细的眼底镜检查、眼底彩色照相及荧光素眼底血管造影(Fundus fluorescein angiography, FFA) 检查。结果: 眼底陈旧性出血灶 ICGA 均表现出相应的自发荧光。陈旧性出血灶呈浅灰黄色, 其自发荧光的形态大小与眼底彩色图像所示的陈旧性出血灶相一致, 边界清晰; 造影后期陈旧性出血灶的自发荧光强度最强, 与 AMD 的斑状及焦点状脉络膜新生血管 (Choroidal neovasculari-zation, CNV) 及 PCV 的息肉状脉络膜血管扩张灶的荧光表现不同。陈旧性眼底出血的自发荧光多与 CNV 或息肉状病灶重叠或位于其边缘(27 只眼, 75%) 。结论: ICGA 中陈旧性眼底出血所致的自发荧光易与 CNV 及息肉状病灶性强荧光相混淆, 将眼底彩色图像与 ICGA 图像对比分析及掌握其与CNV及息肉状血管扩张灶的不同荧光特性有助于鉴别诊断。
Objective: To investigate the autofluorescence of stale fundus haemorrhage in age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV)with indocyanine green angiography (ICGA) .Methods: The color photographs and ICGA were performed in 36 eyes of 36 cases of exudative AMD or PCV with stale fundus haemorrhage. All of the cases were examinedby funduscopy and fundus fluorescein angiography (FFA) .Results: Autofluorescence could be observed in all of the stale haemorrhage cases. Stale haemorrhage showed grayish color and the shapes and sizes of autofluoresence in ICGA were in accordance with those of the stale haemorrhage in the color photographs. The boundaries of autofluorescence were clear and the intensities were strong. The percentage of choroidal neovascularization (CNV) or PCV in or beside stale haemorrh-age was significantly higher than that outside the stale haemorrhage (27 eyes, 75%) .Conclusions: Autofluorescence of stale haemorrhage in ICGA can be mixed up with the high fluorescence of CNV and grapes-like polypoidal dilatation. It is helpful to compare the color photographs with ICGA and recognize the different ICGA characteristics in the assessment of ICGA results in these circumstances.
青光眼是一组以病理性眼压升高为主要危险因素的,以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术,其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成,并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛,早期主要用于各类难治性青光眼患者,特别是晚期及绝对期患者,研究者发现其除降眼压外,还能够显著缓解该类患者的局部疼痛。近年来,UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中,也表现出了良好的降眼压效果,同时显示出较少的并发症和较轻的术后反应,并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异,且为达最佳治疗效果,其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法,测算精度并不适用于国人,然而精准度更高的模型法,其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量,但术后用药策略的调整仍可能导致眼压波动。综上,针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等,仍有待开展相关临床研究,以期为其临床应用提供更加可靠的依据。
青光眼是一组以病理性眼压升高为主要危险因素的,以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术,其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成,并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛,早期主要用于各类难治性青光眼患者,特别是晚期及绝对期患者,研究者发现其除降眼压外,还能够显著缓解该类患者的局部疼痛。近年来,UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中,也表现出了良好的降眼压效果,同时显示出较少的并发症和较轻的术后反应,并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异,且为达最佳治疗效果,其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法,测算精度并不适用于国人,然而精准度更高的模型法,其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量,但术后用药策略的调整仍可能导致眼压波动。综上,针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等,仍有待开展相关临床研究,以期为其临床应用提供更加可靠的依据。