单纯Nd∶YAG激光、氪红激光或两种激光联合虹膜松解术治疗严重虹膜后粘连  

Synechiolysis by Nd∶YAG Laser,Krypton Red Laser or Their Combination to Treat Iridocapsular Adhesions

作　　者：王润生[1] 吕沛霖[2] 杜善双[1] 雷晓琴[1] 

机构地区：[1]西安市第四医院眼科暨西安市眼底病研究所,西安市710004 [2]西安市第一医院眼科

出　　处：《中国激光医学杂志》2011年第5期295-299,339,340,共7页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的探讨单纯Nd∶YAG激光、氪红激光或两种激光联合虹膜松解术治疗严重虹膜后粘连的有效性。方法强散瞳药物散瞳治疗无效的严重虹膜后粘连134例155只眼,男性76例,女性58例;年龄21～70岁。滴散瞳药物半小时后角膜表面放置眼前节激光接触镜后行虹膜后粘连松解激光治疗,对粘连膜较薄而透明、界限清晰且色素较少者应用单纯Nd∶YAG激光治疗,波长1 064 nm,能量0.3～2.4 mJ;对色素为主的粘连而且粘连区虹膜与晶状体界限不清者应用单纯氪红激光,波长647 nm;光斑直径100～500μm,时间0.1～0.3 s,功率0.3～0.5 W;对色素性粘连较厚者以两种激光联合操作治疗。结果 155只眼中经激光粘连松解术后粘连全部解除瞳孔近圆者102只眼;粘连大部分解除,瞳孔不圆者53只眼。术后瞳孔立即扩大至直径≥6.5 mm者111只眼,占71.6%;瞳孔扩大至直径5.5～6.4 mm者24只眼,占15.4%;瞳孔直径≤5.5 mm 20只眼,占13%。术中瞳孔扩大见晶状体不同程度混浊者107只眼,其中轻度浑浊者52只眼,瞳孔中央混浊或极化膜残留者32只眼;严重混浊者23只眼。术后视力≤0.08者由术前的57%降低到15%,而术后视力0.1～0.4和0.5以上者则分别由术前的31%、12%上升到59%、26%。轻度前房积血13只眼,晶状体前囊膜损伤2只眼。结论单纯Nd∶YAG激光、氪红激光或两种激光联合术进行严重虹膜后粘连松解是一种简便、安全、有效的方法,值得推广。Objective To access the effectiveness through synechiolysis by Nd∶YAG laser,krypton red laser or their combination to treat severe iridocapsular adhesions. Methods The medical records of 134 cases（76 males and 58 females of 21 to 70 years old,average of 48.3 years） with 155 eyes affected severe iridocapsular adhesions and synechiae were analyzed respectively.Half an hour after drop mydriatic,the ocular surface cornea touching mirror was placed on anterior segment to use laser to loose iris adhesion.The selected laser parameters： Lumenis Nd∶YAG laser（USA）（1064nm with wavelength and 0.3-2.4mJ with energy）;or krypton red laser（USA）（wavelength with 647nm,100-500μm laser spot,and 0.1-0.3 seconds with illumination time,0.3-0.5W with energy）,and two laser joint operation treatment. ResultsFrom 155 eyes after laser synechiolysis the diameter of pupils to expanding up to 6.5mm was in 111 eyes,accounted for 71.6%;to 5.5-6.4mm diameter in 24 eyes,accounted for 15.4%;and to less than 5.5mm was in 20 eyes.The lens with different degree of turbidity was seen in 107 eyes,among them the 52 eyes were with early opacification,32 eyes were with pupil central cloudy or residual polarization,and 23 eyes were with severe cloud.The acuity of lower than 0.08 was from 57% pre-operation reduced to 15% post-operation,and that of 0.1-0.4 and higher than 0.5 was increased from 31-12% to 39-26%.Anterior chamber mild damage hemorrhage in 13 eyes and anterior lens capsule damage by laser in 2 eyes were occurred. ConclusionsWith suitable indications,Nd∶YAG laser,red krypton laser or their combination can achieve the elimination of iridocapsular adhesion with minimal complications.It is a simple,safe and effective method deserving promotion.

关 键 词：虹膜后粘连 激光 松解术 

分 类 号：R779.6[医药卫生—眼科]