摘要：青光眼是全球首位不可逆性致盲性眼病，因其可以导致不可逆性损害，所以治疗颇为棘手。虽然随着科技和医学的不断进步，青光眼治疗领域出现了许多新药和新型手术技术，但一些难治性青光眼依旧令眼科医师感到头疼。睫状体破坏性手术在某些难治性青光眼中，为降低患者的眼压、保留其视

青光眼是全球首位不可逆性致盲性眼病，因其可以导致不可逆性损害，所以治疗颇为棘手。虽然随着科技和医学的不断进步，青光眼治疗领域出现了许多新药和新型手术技术，但一些难治性青光眼依旧令眼科医师感到头疼。睫状体破坏性手术在某些难治性青光眼中，为降低患者的眼压、保留其视功能起到了重要作用。在第39届世界眼科大会（WOC2024）上，《国际眼科时讯》有幸邀请到WOC2024学术委员会共同主席、阿根廷布宜诺斯艾利斯大学医学院眼科研究所的Fabian Lerner教授进行专访，Fabian Lerner教授详细介绍了睫状体破坏性手术的目的、安全性、应用时机和适用范围，并强调一定要在明确确定该手术的疗效和安全性以后再考虑联合其他眼科手术进行治疗。

《国际眼科时讯》您在WOC2024会上分享了睫状体破坏性手术的应用经验，请问应用睫状体破坏性手术的目的是什么？

Fabian Lerner教授：睫状体破坏性手术用于降低青光眼患者的眼压。有多种方法可以减少房水的生成，所以睫状体破坏性手术可以通过电透热术、冷冻术、超声波或激光光凝术等多种不同的方式进行。近期，我们使用激光进行睫状体破坏性手术。对于激光的选择，眼科医师可以选择Nd:YAG激光或二极管激光。最受欢迎的是二极管激光，它可以连续的方式使用，也可以微脉冲的方式使用，最常用的方法是微脉冲二极管激光睫状体光凝术。眼科医师也可以通过瞳孔使用激光，即内激光，但最常用的方法还是经巩膜使用激光。

Cyclodestruction procedures are used to reduce the intraocularpressure in glaucoma. There are several ways to reduce the production of aqueous humor with ciclodestruction: you can use diathermy, cryotherapy, ultrasound or laser. Lately, we are using lasers. For the lasers, you can use Neodymium YAG or you can use diode laser. The most popular is diode laser, and it can be used in a continuous way, or it can be used in a way known as MicroPulse. The most popular way of doing this nowadays is the MicroPulse transscleral cyclophotocoagulation. You can also use lasers through the pupil or endolaser. But the most popular approach is transscleral.

《国际眼科时讯》睫状体破坏性手术的安全性一直备受关注，您认为何时才能应用睫状体破坏性手术？

Fabian Lerner教授：在过去，睫状体破坏性手术的安全性引起了人们的关注，特别是手术后的低眼压令人担忧。如果患者出现低眼压，有时要提高眼压是很困难的，眼科医师知道如何降低眼压，但往往不知道应该如何提高眼压。如今微脉冲可使眼科医师以更安全的方式进行睫状体破坏性手术，微脉冲交替开启和关闭能量循环，使用激光时，时而工作，时而不工作。我通常会向我的患者解释，这种激光的工作原理就像汽车中的ABS制动系统，当车辆制动时，ABS会在部分时间内制动，部分时间内不制动，微脉冲也是如此。

That is a good point. In the past, cyclodestruction has caused concerns, particularly with hypotony. If the patient gets hypotony, it is sometimes very difficult to get intraocular pressure up. We know how to bring it down, but we don’t know how to bring it up. The new way of doing cyclodestruction, MicroPulse cyclodestruction, allows us to use this procedure in a safer way, The MicroPulse alternates on and off cycles of energy. When using the laser, part of the time it is working, and part of the time it is not working. I usually explain to my patients that this laser works like the ABS brake system in their car. When you use the brake, the ABS applies the brake for part of the time, and for part of the time, it doesn’t apply the break. It is the same with MicroPulse.

《国际眼科时讯》与过去相比，现在睫状体破坏性手术的适用范围是否有所改变？

Fabian Lerner教授：现在有一种趋势是扩大微脉冲睫状体破坏性手术的适应证，将其应用于既往未接受过青光眼手术的患者。在我看来，现在这样做还为时过早，我们需要更多数据，需要进行更多随机临床试验来确定微脉冲睫状体破坏性手术应用于初次接受青光眼手术的患者的有效性和安全性。到目前为止，我们已将微脉冲睫状体破坏性手术应用于既往青光眼手术失败的患者、眼部疼痛的患者、角膜移植术后青光眼患者、一些继发性青光眼患者，或者居住在很远的地方需要进行传统青光眼手术但无法频繁来医院进行术后随访的患者。

There is a tendency now to move the use of MicroPulse cyclodestruction towards more newer indications, meaning people who did not receive a previous surgical procedure for glaucoma. In my opinion, it is still very early to be doing so. We need more data. We need more studies and randomized clinical trials in order to establish completely the efficacy and safety of the procedure to be able to indicate it in patients naive of surgical procedures. So far, we are using it in patients who have had previous failed surgical procedures, patients who have pain, patients who have glaucoma post-keratoplasty, some secondary glaucomas, or in patients who live far away and cannot come back for the frequent post-operative visits that are usually needed in traditional procedures.

《国际眼科时讯》睫状体破坏性手术是否可与其他降眼压手术联合使用？

Fabian Lerner教授：我刚才谈到过，我们必须明确确定睫状体破坏性手术的安全性和有效性。我认为在将睫状体破坏性手术与其他手术联合之前，最好将其作为独立的手术，在确定了该手术的疗效和安全性范围后，再考虑与其他手术联合。有研究表明，眼科医师可以进行超声乳化白内障吸除术联合经巩膜二极管睫状体光凝术，该文章已经发表，但这不是我会选择的手术方式。

I just told you that we have to establish exactly the safety and efficacy of the procedure. I think it is better to establish this as a stand-alone procedure before combining it with other procedures. After establishing the scope of efficacy and safety then, yes, why not, we can combine this with other procedures. This procedure has been combined, for instance, with cataract surgery. It has been published that you can do phacoemulsification and transscleral diode cyclophotocoagulation. That is not my procedure of choice, but it has been published already.

来源：健康讲堂分享