YAG激光虹膜透切术对闭角型青光眼患者的角膜内皮的影响研究及患者心理健康评估  

Effect of YAG laser peripheral iridotomy on corneal endothelial and mental health assessment in patients with angle closure glaucoma

作　　者：张恩慧 鲍晓敏[2] 沙晶晶 哈玲芳[2] ZHANG Enhui;BAO Xiaomin;SHA Jingjing;HA Lingfang(College of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Department of Ophthalmology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750004 [2]宁夏医科大学总医院眼科,宁夏银川750004

出　　处：《宁夏医学杂志》2023年第6期504-507,共4页Ningxia Medical Journal

基　　金：宁夏医科大学科学研究基金资助项目(XY2017150)。

摘　　要：目的探究YAG激光虹膜透切术对急性闭角型青光眼患者的角膜内皮的影响并对患者心理健康进行评估。方法本研究为前瞻性研究,收集接受YAG激光虹膜周边透切术的急性闭角形型青光眼临床前期患者38例(57只眼)。根据术中所用激光有效总能量的高低将患者分为3组,能量小于等于20 mJ为低能量组(21只眼),20~45 mJ为中等能量组(20只眼),大于45 mJ为高能量组(16只眼)。术前、术后1周、1个月、3个月采用非接触型角膜内皮计检测患者角膜内皮的变化,包括细胞密度(ECD)、六角形细胞百分比(6H)、平均细胞面积(AVG)。38例患者在激光术前及术后1周,通过填写焦虑自评量表(SAS)及抑郁自评量表(SDS)进行心理健康评估。结果低能量组术前、术后1周、1个月、3个月的角膜ECD、6H、AV变化差异无统计学意义(P>0.05);中能量组不同时间ECD的变化差异无统计学意义(P>0.05),术后1周、1个月、3个月6H较术前减少(P<0.05),术后1个月、3个月AVG较术前增大(P<0.05);高能量组术后1个月、3个月ECD及6H均减少(P<0.05),AVG增大(P<0.05);术后焦虑评分、抑郁评分较术前下降(P<0.05)。结论低能量YAG激光周边虹膜透切术对角膜内皮相对安全,中、高能量YAG激光对角膜内皮有一定的损伤;YAG激光周边虹膜透切术能有效改善闭角型青光眼患者的心理健康状况。Objective To explore the effect of the laser peripheral iridotomy on corneal endothelium of patients with acute angle closure glaucoma and evaluate their mental health.Methods In this prospective study,38 cases(57 eyes)with primary angle closure glaucoma who underwent YAG laser peripheral iridectomy were collected.According to the effective total energy of the laser used during surgery,patients were divided into three groups:patients whose total energy in operation was smaller than 20 mJ were in low-energy group(21 eyes),whose total energy between 20mJ and 45mJ were in intermediate energy group(20 eyes),whose total enemy more than 45mJ were in high-energy group(16 eyes).Morphology of corneal endothelial were assessed by using noncontact specular microscopy(Topcon SP-3000P).A specular microscopy was performed at baseline after 1 week,1 month and 3 months.All the patients were asked to complete the following questionnairs:self-rating Anxiety Scale(SAS),self-rating Depression Scale(SDS).Results There were not a significant difference in ECD,6H,AVE,CV in low-energy group eyes from baseline to1 week,1month and 3months(P>0.05).There was difference in ECD changes in intermediate energy group in different time(P>0.05).The average cell area became larger compared 1month,3 months to baseline(P<0.05).But the eyes in high-energy group showed more progressive corneal endothelial cell loss(P<0.05).The percentage of ECD and 6H decreased and AVE increased in the high-energy group at 1 and 3 months after surgery(P<0.05).The scores of SAS and SDS were decreased after YAG laser peripheral iridotomy(P<0.05).Conclusions Low energy laser for YAG LPI is relatively safe for corneal endothelium,while medium and high energy YAG lasers can cause certain damage to corneal endothelium.YAG laser peripheral iridectomy can effectively improve the mental health of patients with angle closure.

关 键 词：YAG激光周边虹膜透切术 急性闭角型青光眼 角膜内皮 焦虑 抑郁 

分 类 号：R779.6[医药卫生—眼科]