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目的 探讨激光周边虹膜切除术联合激光前房角成形术治疗原发性闭角型青光眼的疗效及安全性。设计 回顾性、非对照病例研究。研究对象 原发性闭角型青光眼82例(112只眼)。方法 本组原发性闭角型青光眼病例,先行激光周边虹膜切除术,1周后行激光前房角成形术。主要指标 术前、术后观察眼压、视力、房角、视野、并发症。结果 随访6～18个月,平均11个月。激光治疗前眼压为(2 8 89±8 5 6 )mmHg ,治疗后为(19 98±7 37)mmHg(P <0 0 1)。93只眼(83 0 3% )眼压≤2 0 5 5mmHg ,其中2 4只眼需用抗青光眼药物,但点药次数较激光治疗前减少。19只眼(16 96 % )眼压未控制。视力提高32只眼(2 8 5 7% ) ,下降4只眼(3 5 7% ) ,不变76只眼(6 7 86 % )。10 4只眼(92 86 % )房角有不同程度增宽,8只眼(7 14 % )房角变化不明显。房角粘连范围减少90°以上或重新开放者6 6只眼(89 12 % ) ,不变者8只眼(10 81% )。激光治疗前后视野无明显变化。并发症:5只眼(4 4 6 % )瞳孔轻度扩大;13只眼(11 6 % )一过性眼压升高。结论 激光周边虹膜切除术联合前房角成形术治疗房角粘连范围小于3个象限的原发性闭角型青光眼创伤小,降眼压效果好,并发症较少。
Objective To investigate the efficacy and safety of laser peripheral iridotomy combined with laser anterior angle angioplasty in the treatment of primary angle-closure glaucoma. Design retrospective, uncontrolled case studies. The study included 82 eyes of primary angle-closure glaucoma (112 eyes). Methods This group of primary angle-closure glaucoma cases, the first laser peripheral iridectomy, 1 week after laser anterior chamber angle angioplasty. The main indicators of preoperative and postoperative intraocular pressure, visual acuity, angle, visual field, complications. The results were followed up for 6 to 18 months, an average of 11 months. The intraocular pressure before laser treatment was (2 8 89 ± 8 5 6) mmHg and after treatment was (19 98 ± 7 37) mmHg (P 0 01). Ninety-three eyes (83 0 3%) had intraocular pressure ≤2 05 mmHg, in which 24 eyes needed anti-glaucoma medication, but the number of prescriptions was less than that before laser treatment. Nineteen eyes (16 96%) did not control intraocular pressure. Eyes improved by 32 eyes (2857%), decreased by 4 eyes (37%), unchanged 76 eyes (67%). 10 4 eyes (92 86%) had different degrees of widening of the angle, 8 eyes (7 14%) of the angle was not obvious. There were 66 eyes (89.12%) with a decrease of more than 90 ° in the angle of adhesions, or 8 eyes (10.81%) in the untreated area. There was no significant change in the visual field before and after laser treatment. Complications: slight pupil enlargement in 5 eyes (446%); transient elevated intraocular pressure in 13 eyes (11 6%). Conclusion Laser iridectomy combined with anterior chamber angle angioplasty in the treatment of primary angle-closure glaucoma with less than 3 quarters in the corner of the corner has less trauma and less intraocular pressure, and has fewer complications.