| Objective Analysis of the relevant factors that affect postoperative intraocular pressure in the use of TDLC treatment of advanced different types of glaucoma. And explore a more effective way to control postoperative intraocular pressure with TDLC to treat advanced different types of glaucoma.Methods This study includes two parts:The first part, a retrospective review of 84 eyes (84 patients) with advanced different types of glaucoma treated in our hospital from 2007to2008. Age, gender, type of glaucoma, laser points, preoperative and postoperative IOP, preoperative and postoperative visual acuity, complications were recorded and the related factors which may effect postoperative IOP of TDLC were analyzed.The second part, a prospective study of 27 eyes (27 patients) with advanced different types of glaucoma. According to the first part of the study results, we proposed that patients are divided to 3 different groups according to pre-treatment IOP, in the same laser power and duration time, patients are treated with different laser points with TDLC. The first group, preoperative intraocular pressure ranges from 22 to 30 mmHg, so laser dots are 50 points; in the second group, preoperative IOP ranges from 31 to 50 mmHg, so laser dots are 70 points; in third group, patients pre-treatment IOP ranges from 51to70 mmHg, so laser dots are 90 points. Each case of postoperative visual acuity, postoperative intraocular pressure, complications are observed, and patients with glaucoma are compared to retrospective study to evaluate the efficacy. Follow-up the intraocular pressure after 1 day,7 days,14 days, after 30 days,60 days,90 days and 180 days postopratively, and the medium-term effect of TDLC is evaluated.Results The first part, the results were statistically analyzed and with respect to diagnosis, age, sex and pre-treatment IOP. If we consider sex, age, laser dots, pre-treatment IOP as controlling variable, we analyzed the relation between after-treatment IOP and diagnostic category of glaucoma. The partial correlation coefficient r=0.2934, P=0.0230.05. Similarly, analyzed the relation between after-treatment IOP and pre-IOP, the partial correlation coefficient r=0.6123, P =0.000<0.05. Analysed the relation between after-operation IOP and sex, the partial correlation coefficient r=-0.0092, P=0.945>0.05, there is no statistical significance. And analyzed the relation between after-operation IOP and age, the partial correlation coefficient r=-0.1053, P=0.427>0.05. Analysed the relation between the reduction of IOP and laser dot, the correlation coefficient r=0.279, P=0.036< 0.05, there is statistically significant.The second part, using the new method of different laser dots of TDLC according to pre-treatment IOP, the success rate afterTDLC is raised from 26.19% of the previous method to 37.04%. After 6 month of operation, the success rate of TDLC is 92.5%. As time goes by, the after-treatment IOP has decreased gradually, and more and more get close to normal. Few complications occurred and TDLC seems not to lead to decreased visual acuity.Conclusion1. TDLC was found to be simple, effective and safe in reducing IOP in treatment of advanced different types of glaucoma.2. The outcome of TDLC seems to be related to the type of glaucoma and pre-treatment IOP, but that has no relation to the age and sex of the patients. The IOP reduction has positive correlation with the laser dots in the treatment.3. To be treated with different laser dot of TDLC according to pre-treatment IOP is safe, feasible, and can more effectively control postoperative IOP in Chinese advanced glaucoma patients. And that neither increases the incidence of complications nor decreases postoperative visual acuity.4. As time goes by, TDLC postoperative intraocular pressure is gradually and steadily declining to normal.
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