高度近视有晶状体眼人工晶状体植入前联合激光与单一激光虹膜周切术的临床效果比较  

Different Laser Iridotomy Before Phakic IOL Implantation for Correction of High Myopia:a Clinical Observation

作　　者：朱彩红[1] 张士胜 廉井财[1] 周颖明[1] 张琼[1] 廖华萍 孙昕[1] 孙静芬[1] 周正申[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院眼科,上海市200025 [2]上海瑞视眼科

出　　处：《中国激光医学杂志》2010年第5期282-285,共4页Chinese Journal of Laser Medicine & Surgery

基　　金：上海市重点学科建设项目资助(S30205)

摘　　要：目的比较和分析高度近视有晶状体眼人工晶状体(phakic IOL)植入前应用Ar+激光联合Nd∶YAG激光虹膜周切术和单纯Nd∶YAG激光虹膜周切术的成功率和临床变化。方法高度近视眼患者60例112只眼随机分为两组,一组为联合激光组54只眼,先应用Ar+激光对拟周边虹膜切开部位进行环形击射,再以Nd∶YAG激光进行集中击射,直至将虹膜切开孔直径≥2.0 mm;另一组为单一激光组58只眼,直接应用Nd∶YAG激光对选定拟周边虹膜切开部位进行击射,直至虹膜切开孔直径≥2.0 mm。激光术后进行人工晶状体植入手术,比较两种方法治疗后患者的眼压变化、角膜内皮细胞损伤及并发症情况。结果 (1)联合激光组和单纯Nd∶YAG激光虹膜周切术术前平均眼压分别为(15.54±2.84)mmHg、(15.32±2.58)mmHg,术后30 min平均眼压分别为(16.96±3.90)mmHg、(16.43±4.57)mmHg,较术前均有升高(P<0.05),但两组间差异无统计学意义(P>0.05)。(2)联合激光组和单一激光组虹膜周切术术前角膜内皮细胞密度分别为(3 151.2±232.3)个/mm2、(3 158.3±236.5)个/mm2,phakic IOL植入术后1个月分别为(3 068.1±265.9)个/mm2、(2 972.3±290.3)个/mm2,较术前均有降低(P<0.05),但两组间变化幅度比较差异无显著意义(P>0.05)。(3)联合激光组仅1只眼需行二次激光手术,16.7%发生虹膜出血,出血量较少;而Nd∶YAG单一激光组5只眼行二次激光手术,25.9%发生虹膜出血,出血量相对较多。结论联合激光手术对高度近视phakic IOL植入术前虹膜周切术较单纯Nd∶YAG激光虹膜周切术有优越性,虹膜切开成功率较高,出现并发症较少。Objective To compare the success rate and clinical changes of argon-Nd∶YAG laser iridotomy with Nd∶YAG laser iridotomy alone before phakic intraocular lens（IOL） implantation for correction of high myopia.Methods Sixty cases of high myopia（112 eyes） were randomly divided into two groups,one group was performed iridotomy using combination of argon-Nd∶YAG laser,and the other group accepted Nd∶YAG laser iridotomy alone.Then the phakic IOL were implanted.The changes in intraocular pressure（IOP）,corneal endothelial cell injury and complications were recorded and compared.Results（1） The mean IOP was（15.54±2.84） mmHg（argon-Nd∶YAG laser group） and（15.32±2.58） mmHg（Nd∶YAG laser group）,respectively,before laser iridotomy.Thirty minutes after laser treatment,the average IOP increased to（16.96±3.90） mmHg and（16.43±4.57） mmHg,respectively,whereas the IOP was higher than the preoperative（P0.05）,the changes were not statistically significant between the two groups（P0.05）.（2） The corneal endothelial cell density was（3 151.2±232.3） cells/mm2（argon-Nd∶YAG laser group） and（3 158.3 ± 236.5） cells/mm2（Nd∶YAG laser group）,respectively,before laser iridotomy.One month after Phakic IOL implantation,the cell density decreased to（3 068.1±265.9）cells/mm2 and（2 972.3±290.3）cells/mm2,respectively.While the cell density was lower than before operation（P0.05）,there was no statistically significant difference between the two groups（P0.05）.（3） For argon-Nd∶YAG laser group,the repeated laser treatment was required in 1 eye,small iris bleeding occurred in 16.7% eyes.And for Nd∶YAG laser group,5 eyes underwent secondary laser,25.9% eyes went into iris bleeding with a relatively large amount.Conclusions Due to the high success rate and fewer complications,the combination of argon-Nd∶YAG laser iridotomy is better than the Nd∶YAG laser iridotomy alone before phakic IOL implantation for treatment of high myopia.

关 键 词：高度近视 激光治疗 虹膜切除术 

分 类 号：R779.6[医药卫生—眼科]