| Sažetak | U uvodnom dijelu ovog rada naglašena je uloga povišenog
očnog tlaka kod glaukoma i značaj različitih terapeutl!
lkih medikamentoznih i kirurških postupaka da se on snizi.
Zatim, slijedi kratak povijesni pregled, te objašnjenje
osnovnih principa fotokoagulacije i njenog djelovanja na tkivo
oka, posebno na njegov prednji segment.
Nakon kratkog tumačenja karakteristika laserskog
zračenja, opisane su različite metode i postupci primjene
argon laserske fotokoagulacije u tretmanu glaukoma.
Posebno je naglašena i opširnije opisana laserska
trabekuloplastika, obzirom na njenu danas sveopće prihvaćenu
primjenu i važnost u tretmanu odredjenih vrsta glaukoma.
U radnom dijelu izneseni su rezultati izvršene argon
laserske trabekuloplastike na 161 oku kod 120 bolesnika
sa glaukomom otvorenog ugla, gdje se maksimalno podnošljivom
medikamentoznom terapijom u prosječnom trajanju od 1,2 godine
(od 3 mjeseca do 4 godine) nije mogla postići zadovoljavajuća
kompenzacija glaukomske bolesti.
U jednoj seansi nije nikada koaguliran sektor komornog
ugla veći od 120°, a pečati su plasirani većinom na
granicu filtrirajućeg i nefiltrirajućeg dijela trabekuluma.
Kontrolni period ("follow-up") tretiranih bolesnika
se kretao od 6 mjeseci do 2 godine, sa prosjekom od
14,3 mjeseca. Uspjeh je postignut u 138 očiju ili 85,71 ± 5,5~,
dok je u 23 oka ili 14,29 ± 5,52% zbog neuspjeha tretmana,
trebalo učiniti filtracioni kirurški zahvat. Samo 7 od 14 bolesnika
iz ove grupe neuspješno tretiranih bilo je mladjih
od 50 godina.
Tim našim načinom tretmana je očni tlak u svih bolesnika
snižen za 39,26% i to u muškaraca za 39,41~, a užena
za 39:05%.
lJi očima sa pseudoeksfolijacijskim sindromom, kojih
je u nas bilo 56 ili 34,78% nije postignut statistički
signifikantno bolji uspjeh, nego u ostalih vrsta glaukoma
(P<.0,05).
Utvrdjeno je medjutim statistički signifikantno
povećanje koeficijenta istjecanja C (P~0,01) i to za 69,72%
uz istovremeno sniženje očnog tlaka za 35,88%, ali bez statistički
signifikantne korelacije izmedju te dvije veličine.
Tim postupkom gotovo da i nije bilo komplikacija,
te je samo u 15,09% očiju došlo do lagane iritične reakcije,
koja je obično kroz dva do tri dana potpuno iščezla.
Do postfotokoagulacijskog povećanja očnog tlaka
neposredno nakon trabekuloplastike došlo je samo u 5 ili
3,10% očiju, no nijednom nije trebalo kirurški intervenirati,
jer je ubrzo tlak medikamentozno reguliran.
Samo 15 ili 12,5% bolesnika je zbog laserskog
tretmana bilo hospitalizirano, dok je u svim ostalim slučajevima
zahvat s uspjehom vršen ambulantno. |
| Sažetak (engleski) | The role of elevated eye pressure in glaucoma
and the importance of different proceedings, medicamentous
and surgical as well to lower it, are pointed out in the
introductory part of this work.
A brief historical overview
explaination of basic principles of
is followed by an
the photocoagulation
and its interaction with ocular tissues of the anterior
eye segment particularly.
Explained the laser radiation, different methods
and ways of application of the argon laser photocoagulation
in ~laucoma treatment are described.
To argon laser trabeculoplasty, because of its
generally accepted application and importance in modem
treatment of certain types of glaucoma, more space is dedicated.
In the working part results are reported of argon
laser tra·beculoplasty performed on 161 eyes of respecti
vely 120 patients with open-angle glaucoma, where despite
of maximum tolerated medical therapy after an average lapse of time of 1,2 years (ranging from 3 months to 4 years),
the glaucomatous disease remained still uncontrolled.
Ina single session was never coagulated more than
120° of angle circumference, with photocoagulation spota mostly
placed on the junction of pigmented filtering and unpigmented
non-filtering trabecu1ar meshwork.
The follow-up period of all treated patients ranged
from 6 months to 2 years, with an average time of 14,3 months.
Success was achieved in 138 eyes or 85,71 ± 5,52%,
meanwhile in 23 eyes or 14,29 ± 5,52% surgery was necessary.
Only 7 of 14 patients in this group of unsuccess were under
50.
This kind of treatment decreased the eye pressure
for 39,26% in all patients, 39,41% in men and 39,05% in women.
The treatment was not statistically more significant
(P<0,05) in 56 eyes (34,78%) with pseudoexfoliation,
than in other types of glaucoma.
A statistically significant elevation of outflow
facility C (P<.0,01) of 69,72% assoeiated with a drop of eye
pressure of 35,88% was established,however without any statistical
signification between these two values.
This proceeding caused practically no complications
at all, because in only 15,09% of treated eyes there was a
slight flaring in the anterior chamber disappeared quickly
ina few days (two or three).
In only 5 eyes or 3,10% the intraocular pressure
increased immediately after trabeculoplasty, but the situation
could be put under control by medical therapy and no surgery was required.
Hoapitalization was necessary in only 15 patients.
In all other cases the treatment was very easily performed
on an outpatient basis. |
