氪红激光周边虹膜成形术治疗急性发作期闭角型青光眼  

Treatment of acute attack of primary angle closure glaucoma with Krypton red laser peripheral iridoplasty

作　　者：周少博[1] 胡群英[1] 麦庆怡[1] 孙克清[1] 

机构地区：[1]广州医学院第一附属医院眼科,广州510120

出　　处：《中国实用眼科杂志》2007年第1期72-74,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的研究氪红激光周边虹膜成形术作为首发治疗急性发作期闭角型青光眼的功效和安全性。方法对36例（38眼）急性发作期青光眼且伴有严重肾功能损害的患者随机分成2组，其中一组采用3种局部降眼压药物滴眼治疗，即2％毛果芸香碱、0．5％噻马心胺和派立明眼液滴眼，另一组采用氪红激光作周边虹膜成形术治疗，分别测量治疗前后30min、1h、2h、4h、8h眼压下降值（眼压差），并观察可能出现的并发症。结果激光治疗组眼压在术后30rain、1h、2h、4h、8h分别比术前平均下降（15．3±6．3）mmHg（1mmHg=0．133Kpa）、（27．1±8．5）mmHg、（38．0±5．2）mmHg、（41．5±4．6）mmHg、（43．2±3．4）mmHg，药物治疗组在30min、1h、2h、4h、8h后的平均眼压差分别为（3．2±2．1）mmHg、（11．4±3．3）mmHg、（17．2±5．1）mmHg、（28．6±4．3）mmHg、（41．8±5．2）mmHg，t检验比较两组在治疗后不同时间点的眼压差，在30min、1h、2h、4h的眼压差值均有显著性差异（P=0．02，0．01，0．00，0．02）。激光治疗组角膜水肿在术后2h全部消退，药物治疗组只有13眼（68％）在治疗8h后角膜水肿消退。激光治疗组除部分病例瞳孔保持中等散大外，没有发现其它明显的并发症。结论氪红激光周边虹膜成形术能安全快速地降低眼压，可以有效地终止急性闭角型青光眼的发作，对不能全身应用抗青光眼药物的患者有益，鉴于该方法有使瞳孔扩大的潜在危险，建议联合应用缩瞳剂.Objective To investigate the efficacy and safety of Krypton red laser peripheral iridoplasty as a first treatment of acute attack of primary angle closure glaucoma （PACG）. Methods 38 eyes with acute primary angle closure glaucoma in 36 patients who had suffered severe renal failure were divided into 2 groups. Each patient of medication group received topical eyedrops of 2 percent of pilocarpine, 0.5 percent of timolol and 1% brinzolamide. The other group was treated immediately with Krypton red laser peripheral ifidoplasty. The intraocular pressures （IOP） of pretreatment, 30 mins, 1h, 2h, 4h and 8h after treatment were measured with noncontact tonometer, and the IOP reduction after treatments were documented. Also the possible complications was monitored. Results The IOP was reduced 15.3 ± 6.3 mmHg, 27.1 ± 8.5 mmHg, 38.0 ± 5.2 mmHg 41.5 ± 4.6mmHg and 43.2 ± 3AmmHg at 30mins, 1 hr, 2 hrs, 4hrs and 8hrs after laser procedure, respectively. The IOP of medication group were reduced 3.2 ± 2.1 mmHg, 11.4 ± 3.3mmHg, 17.2 ± 5. 1 mmHg, 28.6 ± 4.3 mmHg and 41.8 ± 5.2mmHg at the same time after treatment ,respectively. The differences between the two groups in the IOP reduction at 30 mins, lh, 2h and 4h was significant with t-test （P=0.02, 0.01, 0.00 and 0.02）. Almost all the corneal edema cleared up 2hrs after the laser peripheral iridoplasty, corneal edema of 13 eyes （about 68%） cleared up 8 hrs after treatment in medication groups. No other complications were encountered but some eyes remain middle pupil after the laser treatment. Conclusions Krypton red laser peripheral iridoplasty appeared could promptly lower the IOP in acute PACG, and effectively break the attack of PACG, it seemed to be safe, especially for those who were contraindicate to systemic anti-glaucoma medications.As the side effect of mydriasis maybe occur,combination of miotic was suggested.

关 键 词：氪红激光 激光周边虹膜成形术 闭角型青光眼 

分 类 号：R775.2[医药卫生—眼科]