选择性激光小梁成形术治疗残余原发性闭角型青光眼的临床评价  

Clinical evaluation of selective laser trabeculoplasty for residual primary 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,南宁市530022

出　　处：《中华实验眼科杂志》2012年第7期650-653,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：南宁市科学技术局科技攻关项目（201003044C-1）

摘　　要：背景选择性激光小梁成形术（SLT）治疗原发性开角型青光眼（POAG）的安全性和有效性已得到人们广泛的认同，但迄今为止SLT治疗闭角型青光眼的研究较少，其效果和安全性尚待临床观察证实。目的评价SLT治疗残余原发性闭角型青光眼（PACG）的疗效及安全性。方法采用病例观察性研究设计。共纳入经激光周边虹膜成形术和／或激光虹膜周边切除术治疗后前房角开放但眼压不能降至正常的闭角型青光眼患者23例33眼，术前平均眼压（24．78±4．48）mmHg，日平均用药指数（1．62±0．66）分。所有眼的前房角能看到小梁网的范围约180。。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，术后随访9个月，定期复查眼压、视力、眼前节炎症反应和房水流畅系数测定值，并用前房角镜检查房角的开放情况。结果本组术眼术后1d，1周，1、3、6、9个月的平均眼压分别为（18．78±4．87）、（18．83．4±3．95）、（19．78±4．48）、（19．63±3．68）、（19．11±3．36）、（21．17±3．14）mmHg，与术前眼压值（24．78±4．48）mmHg比较，术后1～9个月明显下降，差异均有统计学意义（P〈0．05）。各时间点患眼日平均用药指数分别为（1．63．4±0．85）、（1．23±1．01）、（1．25±0．98）、（1．21±1．02）、（1．22±0．86）、（1．69±0．53）分，术后1周，1、3、6个月与术前值的（1．62±0．66）分比较，差异均有统计学意义（P＝0．020、0．026、0．020、0．031）。术后即刻可见睫状体充血和前房闪辉，1周后自然消退。16眼术前和术后3个月的平均房水流畅系数（C值）分别为0．11±0．09和0．23±0．15，差异有统计学意义（P=0．002）。结论SLT能够安全有效地降低部分闭角型青光患者的眼压，但其前提是必须有1／2�Background Selective laser trabeculoplasty（SLT）has been widely accepted for the treatment of open-angle glaucoma. However, there are few reports about its application in treating angle-closure glaucoma so far. Objective This study was to clinically evaluate the safety and efficacy of selective laser trabeculoplasty for primary angle-closure glaucoma with opened anterior angle follow-up surgery. Methods A case-observational design was adopted in this study. A total of 33 eyes from 23 angle-closure glaucomatous patients with opened 180° angle were enrolled. All the patients understood this trial and written informed consent was obtained prior to the medical treatment. The average preoperative intraocular pressure（IOP） and number of medication were （23.07 ±4.01 ） mmHg and 1.52±0. 66, respectively. A frequency doubled Q-switched Nd： YAG laser was used to irradiate the trabecular meshwork with 70-80 laser spots over 180°. The same preoperative anti-glaucoma drugs were topically administered during the follow-up period. Visual acuity,lOP, slit lamp examination, gonioscopy and the coefficient of outflow facility were regularly assessed and performed after laser surgery. Results The lOP values of the 33 eyes were（ 18.78± 4.87）mmHg,（ 18.83 ±3.95） mmHg, （19.78 ±4.48） mmHg, （ 19.63 ±3.68） mmHg, （ 19.11±3.36） mmHg, and（21. 17±3. 14） mmHg 1 day, 1 week, and 1,3,6,9 months after operation, showing significant decline in comparison with preoperation（ P〈0.01 ）. The mean drug uses were 1.63 ± 0.85,1.23 ± 1.01,1.25 ±0.98,1.21 ± 1.02,1.22 ± 0.86,and 1.69±0.53 at the same time point after operation,respectively,and significant differences were found 1 week, 1 , 3,6 months in postoperation in comparison with preoperation （ P = O. 020,0. 026, O. 020,0. 031 ）. Ciliary congestion and aqueous flare naturally disappeared 1 week after surgery. The coefficients of outflow facility were 0. 11 ± O. 09 and O. 23±0. 15, respectively at pretreatment and 3 months after SLT with a s

关 键 词：选择性激光小梁成形术 青光眼/闭角 眼压 

分 类 号：R779.6[医药卫生—眼科]