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  【摘要】目的 探讨半导体激光经巩膜睫状体光凝治疗难治性青光眼的优化方案。方法 采用正交分析方法将63例难治性青光眼分为7个组，每组9个病人，选择激光功率、曝光时间、激光点数及激光范围四个因素，每个因素考虑3个水平，比较不同激光功率、曝光时间、激光点数及范围对眼压的影响，找出诸因素各水平的优化配比。结果 观察13~22个月，激光功率1.8 W、曝光时间1.0 S、激光点数30点、激光范围270°为优化激光参数组合；激光功率、曝光时间、激光点数是影响手术后眼压及手术前后眼压差的主要因素(P0.05)。结论 半导体激光经巩膜睫状体光凝采用优化激光参数组合方案治疗难治性青光眼降低眼压疗效确切，并发症少。

 【关键词】半导体激光 正交分析 难治性青光眼

 中图分类号：R775 文献标识码：A 文章编号：1005-0515(2012)1-027-02

 Preferred plan of transscleral diode laser cyclophotocoagulation for refractory glaucoma

 ZHAO Xin LI Min LIU Luhong YANG Jie ZHONG Haibing

 Department of Ophthalmology,The People’s Hospital of Guangxi Zhuang Autonomous Region (Nanning 530021),China.

 【Abstract】Objective To evaluate the preferred plan of transscleral diode laser cyclophotocoagulation for refractory glaucoma. Methods 63 patients were randomly divided into seven groups. Each group had nine patients.63eyes from 63 patients with refractory glaucoma underwent transscleral diode laser cyclophotocoagulation with different factors, included laser power, time, spots and range. Each factor had 3 levels. The optimum mix radio of laser factors is advanced by orthogonal analysis. Results The patients were followed 13 to 22 months. The optimum mix radio were the treatments with 1.8W for 1.0 second, 30 spots, ranging 270°. Laser power, time and spots were the main factors to IOP. IOP was significantly decreased by transscleral diode laser cyclophotocoagulation(P0.05). Conclusions Preferred plan of transscleral diode laser cyclophotocoagulation for refractory glaucoma is a safe and effective therapy.

 【Key words】Diode laser Orthogonal analysis Refractory glaucoma

 难治性青光眼是眼科常见的棘手的致盲眼病之一，患者不仅视功能很差或丧失，而且疼痛难忍，严重影响工作和学习，挽救这类病人的视功能，解除痛苦，具有重要的社会意义。半导体激光经巩膜睫状体光凝应用于难治性青光眼的治疗，以降低眼压，解除眼球疼痛，近年来成为治疗难治性青光眼的主要手段之一，而不同激光功率、曝光时间、激光点数及激光范围对降低眼压的影响作用大小，许多医师都在不断进行临床实践探讨, 我院2004年3月至2010年6月对63例难治性青光眼采用正交分析方法，探讨半导体激光经巩膜睫状体光凝治疗难治性青光眼的优化方案，现报告如下：

 1 对象与方法

 1.1 对象 纳入标准: ①新生血管青光眼、原发闭角型青光眼已无光感者、外伤性青光眼、无晶体或人工晶体眼青光眼、葡萄膜炎性青光眼、发育性青光眼、滤过手术失败的青光眼等因有高危并发症因素而不适于其它手术者；②用可耐受最大剂量的降眼压药物无法控制，眼压≥30mmHg者；③最佳矫正视力
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