目的：评价药物治疗无效的开角型青光眼及部分复杂性青光眼行二氧化碳激光辅助下外层Schlemm管消融术(CO2 laser-assisted sclerectomy surgery，CLASS)的短期临床安全性及有效性。方法：收集2015年5月至2016年1月解放军总医院眼科行CLASS手术和小梁切除手术的青光眼患者各23例，共46例46只眼。观察术后1周、1个月和3个月眼压及并发症发生情况。结果：两组术后1周、1个月及3个月眼压较术前均明显下降(P=0.000)。术后1周、1个月及3个月时CLASS手术组眼压平均值均低于小梁切除术组，但无统计学差异(P>0.05)。CLASS手术组23例均无浅前房、脉络膜脱离等并发症出现。小梁切除手术组有4例在术后早期出现浅前房，其中1例出现脉络膜脱离，经治疗后均治愈。结论：CLASS手术在有效降低眼压的同时，能大幅降低患者术后出现浅前房等并发症的概率，但其远期降眼压效果及并发症发生情况有待进一步深入研究。
Objective: To evaluate the short-term of clinical safety and efficiency of CO2 laser-assisted sclerectomy surgery (CLASS) in patient with open-angle glaucoma and complicated glaucoma. Methods: Our study involved 46 eyes of 46 patients with glaucoma that underwent CLASS and trabeculectomy respectively by the same surgeon (Zhaohui Li) from May 2015 to January 2016 at the PLA General Hospital. Intraocular pressure and complications 1 week, 1 month and 3 months after operation was observed separately. Results: The intraocular pressure (IOP) 1 week, 1 month and 3 months after surgery decreased obviously (P=0.000). Compared to the trabeculectomy group 1 week, 1 month and 3 months after surgery, IOP of CLASS group was lower. But there was no statistically significant difference between these two groups (P>0.05). There was no complication occurred in CLASS group. Early postoperative complications occurred in trabeculectomy group included shallow anterior chamber and choroidal detachment, and they were all successfully resolved by pharmacotherapy. Conclusion: CLASS operation could reduce intraocular pressure effectively and decrease the incidence of complications, such as postoperative shallow anterior chamber in patients with glaucoma. However, its long-term effect and complications need to be further studied.
青光眼是全世界范围内不容忽视的致盲性眼病，其起病隐匿，视功能损害进展迅速，晚期预后不理想。长期发展且未行治疗的青光眼患者视神经呈进行性损害，引起视力急剧下降、视野不可逆性缺损，严重降低患者的生活质量。为了适应逐渐恶化的视功能，患者注视行为发生明显变化，由此在日常活动中引起步态行为随之改变，意外事故频繁发生。故目前对于青光眼的研究引起国内外广泛重视，虚拟现实技术(virtual reality，VR)作为青光眼早期诊断及康复治疗的新手段已被现代医学所尝试。本文具体阐述了青光眼的视觉损害与注视行为及运动行为间的联系，并总结了目前国内外关于VR诊断青光眼及作为康复治疗的相关研究。
Glaucoma is a blinding eye disease that cannot be ignored worldwide. Its onset is insidious, visual impairment is progressing rapidly, and the late prognosis is not ideal. Long-term untreated glaucoma patients show progressive damage to the optic nerve, causing a sharp decline in vision, irreversible visual field defects, and severely reducing the quality of life of the patients. In order to adapt to the gradual deterioration of visual function, the patient’s gaze behavior changes significantly, which causes the gait behavior to change in daily activities, and accidents occur frequently. Therefore, the current research on glaucoma has attracted wide attention in the nation and abroad,and virtual reality (VR) technology has been tried in modern medicine as a new method for early diagnosis and rehabilitation of glaucoma. This article specifically elaborates the relationship between the visual impairment of glaucoma and the gaze behavior and movement behavior, and summarizes the current domestic and foreign research on the diagnosis of glaucoma and the rehabilitation of VR technology.
