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目的了解激光周边虹膜切开术或联合激光周边虹膜成形术对治疗不同房角粘连状态的原发性闭角型青光眼(PACG)患者的疗效。设计回顾性病例系列。研究对象PACG患者80例(128眼)。方法按房角不同状态分为3组:A组为房角未粘连关闭(37眼);B组为房角粘连关闭小于180°(61眼);C组为房角粘连关闭≥180°,但无明显青光眼性视神经病变(30眼)。全部患者行激光周边虹膜切开术,对于术后眼压仍>21mmHg或暗室试验阳性者,联合激光虹膜成形术治疗。术后随访1～4年。主要指标眼压、用药种类、视力。结果3组病例激光治疗前眼压为(15.5±5.23)mmHg,最后的随访眼压为(14.7±2.8)mmHg(t=2.167,P=0.032);激光治疗后青光眼降眼压用药明显减少(t=13.025,P=0.000)、前房角镜和UBM显示房角不同程度的变宽,激光虹膜切开术后暗室试验阳性者激光虹膜成形术后有91.8%转为阴性。结论本研究结果提示激光周边虹膜切开术或联合激光虹膜成形术不仅对房角粘连关闭小于180°的早期青光眼有效,对房角粘连大于或等于180°的PACG可能同样具有一定的疗效。今后需要前瞻性研究来进一步证实。
Objective To investigate the effect of laser peripheral iridotomy or laser peripheral iridoplasty in the treatment of primary angle-closure glaucoma (PACG) patients with different angles of attachment. Design retrospective case series. The study included 80 patients with PACG (128 eyes). Methods The patients were divided into 3 groups according to the different state of the angle of the angle: Group A was closed with no adhesions (37 eyes); Group B with angle less than 180 ° (61 eyes) However, no obvious glaucomatous optic neuropathy (30 eyes). All patients underwent laser iridectomy, for postoperative IOP still> 21mmHg or darkroom test positive, combined with laser iridectomy. Follow-up 1 to 4 years after surgery. The main indicators of intraocular pressure, type of medication, visual acuity. Results The intraocular pressure (IOP) before laser treatment was (15.5 ± 5.23) mmHg and the last follow-up intraocular pressure was (14.7 ± 2.8) mmHg after laser treatment (t = 2.167, P = 0.032) t = 13.025, P = 0.000). The gonioscopy and UBM showed widening of the angle in different degrees. After the laser iridotomy, 91.8% of the patients in the darkroom positive after laser iridoplasty turned negative. Conclusions The results of this study suggest that laser peripheral iridotomy or laser iridephrectomy is not only effective for early glaucoma with anterior chamber angle closure of less than 180 °, but may be equally effective for PACG with atrial attachment greater than or equal to 180 °. In the future, prospective studies are needed to confirm this.