激光虹膜周边切除术联合激光虹膜成形术与激光周边虹膜切除术在治疗慢性闭角型青光眼的应用效果对比观察  

Two-staged Combination of laser Iridotomy and Iridoplasty Vers Laser Iridoplasty in Chronic Angled-closer Glaucoma

作　　者：张前卫[1] 秦民安[1] 冯梅艳[1] 

机构地区：[1]山东省枣庄市立医院,山东枣庄277102

出　　处：《哈尔滨医药》2009年第3期1-2,共2页Harbin Medical Journal

摘　　要：目的比较激光虹膜切除术分阶段联合激光虹膜成形术与单纯虹膜周边切术在慢性闭角型青光眼中的应用效果。方法100例100只存在房角粘连关闭(PAS>1/2钟点)的慢性闭角型青光眼随机分为试验组(激光虹膜周边切除术联合激光虹膜成行术)和对照组(激光周边虹膜切除术)。激光治疗后1天、3天、7天、2周、1月、3月、6月、12月、18月进行随访,观察视力、裂隙灯、房角镜、视野、眼底、眼压等。结果试验组的平均随访时间为191天,对照组的平均随访时间为180天。完全成功率,试验组为60%(30/50),对照组为58%(29/50),差异不具有显著性(x2=0.003,P=0.955)。试验组治疗后3天的PAS与治疗前比较下降3.1个钟点,而对照组较治疗前下降2.09个钟点,试验组与对照组的这种变化差异具有统计学意义(t=2.358,P=0.02)。进一步对治疗3天与6个月时的房角粘连程度进行比较,3天时PAS范围为2.44±2.25个钟点,6个月时2.95±2.61个钟点,平均增长0.51个钟点(t=2.635,P=0.012),而对照组3天与6个月的PAS无明显变化(t=0.320,P=0.751)。结论激光周边虹膜切除术分阶段联合激光虹膜成形术与激光虹膜切除术治疗原发性闭角型青光眼相比,激光周边虹膜切除术后进行激光周边虹膜成形术可进一步松解房角粘连,激光虹膜成形术又是促使房角粘连进展加快的影响因素。Objective To compare the results of two - staged combination of laser iridotomy and iridoplasty with laser Iridoplasty in choronic angle closure glaucoma. Design randomized, controlled, clinical trial. Methods 100 patients with choronic angle cloure glaucoma, which was defined as peripheral anterior synaechia could be found more than 0.5 clock houre with danymic gonioscopy, were divided into two qroups. In experimentertal group, iridotomy was undergone followed laser iridoplasty one or two days laser, in conter group, only laser iridotomy was performed, Visual acuity, intraocular pressure, slit lamp, gonioscopy, visual field test, fundus examination were done at the post - therapeutive 1 days, 3days, 7days, 2weeks, lmonths, 3months, 6months, 12months, 18months. The main outcome measures IOP, the extent of peripheral anterior synechia and complications. Results 50 patients with 50 eyes of chronic angle closure glaucoma were enrolled into experimental group,50 paients with 50 eyes were enrolen into control group. With a mean follow up time of 6months, the success rate was 60% （30/50） in experimental group and 58% （29/50） in control group with no statistical significance. The extent of PAS reduced one more clock hour in experimental group than that in control group. However, the extent of PAS increased 0.5clock houre in experimental group （ P = 0. 012 ）, the number of endothelial cell counts and complications between two groups was no diffence. Conclusion The efficacy of iridomy followed by iridoplasty for choronic angle closure glaucoma was no diffence with iridotomy only for angle angle closure glaucoma. Although iridotomy can lysis the synechiae of angle closure glaucoma. Although iridotomy can lysis the synechiae of angle, it may also be a factor to pro- mote the progress of PAS thereafter. Long term observation is needed.

关 键 词：激光虹膜成形术 激光周边虹膜切除术 疗效对比 

分 类 号：R775.2[医药卫生—眼科]