选择性激光小梁成形联合激光周边虹膜成形术治疗闭角型青光眼  

Selective laser trabeculoplasty combined with laser peripheral iridoplasty for angle-closure glaucoma

作　　者：周炜[1] 梁日雄[1] 黄焕光[1] 郑洁[1] 陈素梅[1] 

机构地区：[1]南宁市第一人民医院眼科,广西南宁530022

出　　处：《中国实用眼科杂志》2012年第6期738-741,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价选择性激光小梁成形（SLT）联合激光周边虹膜成形术（LPI）治疗闭角型青光眼的疗效及安全性。方法对31例42只原发闭角型青光眼，经LPI治疗前房角被开放。术前平均眼压（24．44±3．26）mmHg，日均用药指数（1．77±0．85）分。所有眼前房角能看到小梁网的范围约180度。用Q开关倍频Nd：YAG激光机在患眼开放的前房角照射小梁网。在180。范围内照射70—80点。术后继续使用术前的降眼压药物，定期复查眼压、视力、眼前节、前房角镜检查和房水流畅系数测定。结果42只眼术后1、7天、1、3、6、9、12月的平均眼压分别为（17．23±3．06）mmHg、（18．15±3．15）mmHg、（19．82±3．22）mmHg、（19．56±2．98）mmHg、（19．01±3．14）mmHg、（20．38±2．94）mmHg、（20．77±3．27）mmHg。与术前相比，术后1．12月眼压有显著下降（P〈0．01），用药指数差异无统计学意义（P〉0．05）。术后即现睫状充血和前房闪辉，不用抗炎眼液1周自然消退。29眼术前和术后3月的房水流畅系数均值分别为0．13±0．09和0．36±0．14，差异有统计学意义（P=O．001）。结论SLT联合LPI能够安全有效降低部分闭角青光患者的眼压，但其前提是必须有1／2周的虹膜小梁角是被开放的。Objective To investigate the safety and efficacy of selective laser trabeculoplasty combined with laser peripheral iridoplasty for primary angle-closure glaucoma. Methods Forty-two eyes of 31 patients with angle-closure glaucoma of 180°angle opened were enrolled in this study. The average preoperative intraocular pressure （lOP） and number of medications （NM） were （24.44±3.26） mmHg and （1.77±0.85）, respectively. The trabecular meshwork （TM） of each eye can be ob- served about 180°, which was irradiated with a frequency doubled Q-switched Nd：YAG laser. Total of 70-80 laser spots were placed over 180° of the TM. Topical antiglaucoma drugs were given as the same as preoperative during the follow up period. Visual acuity, lOP, slit lamp examination, goni- oscopy, and coefficient of outflow facility were regularly performed after laser surgery. Results At the end of 1 day, 1 week, and 1, 3, 6, 9, 12 months of follow-up period, lOP of 42 eyes were 17.23±3.06 mmHg, 18.15±3.15mmHg, 19.82±3.22 mmHg, 19.56±2.98 mmHg, 19.01±3.14 mmHg, 20.38±2.94mmHg, 20.77±3.27 mmHg, respectively. Compared with baseline, there were statistically significant IOP decrease （P 〈 0.01）, and without obviously decrease of NM （P 〉 0.05）, during 1-12 months postoperatively. Ciliary congestion and aqueous flare were disappearance without anti-inflam- matory eye drops 1 week later. Coefficient of outflow facility were 0.13±0.09和0.36±0.14 respective- ly at pretreatment and 3 months after SLT, difference was statistically significant （P =0.001）. Con- clusions Selective laser trabeculoplasty combined with laser peripheral iridoplasty for primary an- gle-closure glaucoma is effective and safe for angle-closure glaucoma, however, it is an essential pre-requisite that 1/2 circle of angle of the anterior chamber is opened.

关 键 词：闭角型青光眼 选择性激光小梁成形术 激光周边虹膜成形术 

分 类 号：R775.2[医药卫生—眼科]