急性发作青光眼手术前激光虹膜成形术的意义  

Clinical significance of Laser iridoplasty on acute attack of glaucoma

作　　者：李勇[1] 肖耀廷[1] 闵颖君[1] 

机构地区：[1]上海市长宁区中心医院眼科,上海200336

出　　处：《中华眼外伤职业眼病杂志》2012年第5期383-386,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察手术前急性闭角型青光眼持续高眼压的情况下，先做激光虹膜成形术的有效性及安全性。方法回顾分析急性闭角型青光眼急性发作期23例（23眼），最大剂量药物治疗后持续高眼压超过48h，首先行激光虹膜成形术，眼压、炎症有效控制后，20眼行复合式小梁切除术（可调整缝线＋术中丝裂霉素C），3眼行白内障超声乳化吸出及人工晶状体植入术。结果激光虹膜成形术前眼压43～82mmHg，平均（66．23±10．40）mmHg，治疗后眼压12～28mmHg，平均（19．59±3．89）mmHg（t=21．503，P=0．000）。小梁切除或白内障手术后3个月19眼眼压8～20mmHg，平均（15．24±2．76）mmHg，治愈率82．61％。4眼眼压21～27mmHg，有效率17．39％。所有患者视力有不同程度提高。结论激光虹膜成形术可以有效降低急性闭角型青光眼持续高眼压患者的眼压，控制炎症，将高风险手术转变为常规手术，二期行青光眼滤过术或白内障超声乳化吸出术成功率高，并发症少。Objective To observe the efficacy and safety of laser iridoplasty for sustained high intraocuiar pressure in acute angle closure glaucoma before surgery. Methods 23 eyes in 23 patients during acute attack of acute angle closure glaucoma were analyzed retrospectively. All the patients had sustained high intraocular pressure （IOP） more than 48 hours after the medical treatment of maximal dose. They underwent laser iridoplasty first and after the IOP and inflammation were effectively controlled, 20 patients underwent trabeculectomy with adjustable suture and Mitomycin C during the surgery. Three patients underwent phacoemulsification and intraoeular lens （IOL） implantation. Results IOP before laser iridoplasty were 43 -82 mm Hg, average （66.23 ±10.40） mm Hg. IOP after laser iridoplasty were 12 -28 mm Hg,average （ 19.59 ±3.89） mm Hg（ t = 21. 503, P = 0. 000）. After 3 months of operation, IOP in 19 eyes were 8 - 20 mm Hg, average （15.24 ±2.76） mm Hg,cure rate was 82.6% , IOP in 4 eyes were 21 -27 mm Hg,effective rate was 17.39%. Visual acuity increased to varying degrees in all patients. Conclusion Laser ifidoplasty can reduce lOP and inhibit inflammation in acute angle closure glaucoma with sustained high IOP, transform the high risk surgery into the conventional surgery. Glaucoma filtration and phacoemulsification in the second stage had higher success rate and less complications.

关 键 词：青光眼 闭角型 虹膜成形术 激光 眼压 

分 类 号：R779.6[医药卫生—眼科]