联合激光与传统药物治疗原发性闭角型青光眼急性发作期的临床研究  

An observation on the treatment of primary acute angle-closure glaucoma with combined laser surgery and traditional medicine

作　　者：张新[1] 郭黎霞[1] 吕爱国[1] 张志宏[1] 崔宏宇[1] 杨艳萍 邵培刚[1] 范肃洁[1] Zhang Xin;Guo Lixia;Lyn Aiguo;Zhang Zhihong;Cui Hongyu;Yang Yanping;Shoo Peigang;Fan Sujie(Department of Ophthalmology,Handan City Eye Hospital(The Third Hospital of Handan),Handan 056001,China)

机构地区：[1]邯郸市眼科医院(邯郸市第三医院)眼科

出　　处：《中华眼科医学杂志（电子版）》2019年第6期354-359,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：河北省医学适用技术跟踪项目(GL2012088)

摘　　要：目的评价激光周边虹膜成形术联合激光瞳孔成形术与传统降眼压药物治疗原发性闭角型青光眼急性发作的有效性和安全性。方法收集2014年1月至2015年7月于邯郸市眼科医院(邯郸市第三医院)就诊的62例(68只眼)确诊为原发性闭角型青光眼首次急性发作并未做降眼压治疗患者的病例资料。其中,男性15例(17只眼),女性47例(51只眼),平均年龄(67.5±8.5)岁,所有患者眼压升高≥40 mmHg(1 mmHg=0.133 kPa)。将入选患者采用数字表法随机分为激光组和药物组。激光组给予激光周边虹膜成形术联合激光瞳孔成形术治疗,药物组给予传统降眼压药物治疗。采用TA03型Icare眼压计测量治疗前、治疗后1 h和2 h的眼压,记录两组角膜及前房情况。以治疗后2 h眼压降至30 mmHg及以下为抢救成功,反之则为治疗失败。激光组和药物组年龄、就诊时眼压和发作时间等资料的描述采用均数±标准差表示,组间比较使用独立样本t检验;两组治疗成功率的描述采用眼数和百分比,比较采用χ~2检验;两组治疗前、治疗后1 h和2 h眼压的比较采用两因素重复测量方差分析。结果治疗后1 h激光组14只眼抢救成功,成功率为41.2%;药物组15只眼抢救成功,成功率为44.2%。治疗后2 h激光组18只眼抢救成功,成功率为52.9%;药物组20只眼抢救成功,成功率为58.2%。治疗后1 h与2 h两组间成功率无统计学意义(χ^2=0.06,0.24;P>0.05)。激光组治疗前视力为光感至0.4,治疗后1 h视力为眼前手动至0.6,治疗后2 h视力为眼前手动至0.6。药物组治疗前视力为光感至0.4,治疗后1 h视力为光感至0.8,治疗后2 h视力为光感至0.8。两组主要并发症为前房内炎症反应和角膜内皮皱褶,无眼内感染和脉络膜下暴发性出血等严重并发症。激光组治疗前、治疗后1 h和2 h平均眼压分别为(56.9±8.7)mmHg、(37.9±16.2)mmHg和(32.9±16.4)mmHg,治疗后眼压下降,与治疗前的比较差异有统�Objective The aim of this study was to evaluate the efficacy and safety of laser peripheral iridoplasty combined with laser pupil plasty in the treatment of acute primary angle-closure glaucoma. Methods From January 2014 to July 2015, sixty-two patients in Handan Eye Hospital(the Third Hospital of Handan) with acute primary angle-closure glaucoma(68 eyes) who were not treated with intraocular pressure reduction for the first acute attack were collected. Among them, 15 cases(17 eyes) were male and 47 cases(51 eyes) were female with an average age of 67.5±8.5 years. All patients had intraocular pressure≥40 mmHg(1 mmHg=0.133 kPa). The enrolled patients were randomly divided into two groups: laser treatment group and drug group. The laser treatment group was treated with combined laser(laser peripheral iridoplasty combined with laser pupil plasty), and drug group was treated with traditional medication. Intraocular pressure was measured by TA03 Icare tonometer before treatment, 1 h and 2 h after treatment,respectively. Changes of cornea and anterior chamber were recorded between groups. Rescue was successful when intraocular pressure dropped to 30 mm Hg or below after 2 h of treatment,and failure to control intraocular pressure below 30 mm Hg after 2 h of treatment was failed treatment. Age,intraocular pressure and onset time in the laser and drug groups were described by mean ± standard deviation. Independent sample t-test was used for inter-group comparison. The number of eyes and percentage were used to describe the power of two components,and chi-square test was used to compare. The comparison of intraocular pressure between two groups before treatment,1 h and 2 h after treatment was performed by two-factor repeated measurement analysis of variance. Results After 1 h after treatment,14 eyes in the laser group were successfully rescued,with a success rate of 41. 2%;15 eyes in the drug group were successfully rescued,with a success rate of 44. 2%;18 eyes in the 2 h after treatment,laser group were successfully

关 键 词：激光周边虹膜成形术 激光瞳孔成形术 原发性闭角型青光眼 急性发作 

分 类 号：R779.63[医药卫生—眼科]