【摘要】  目的 探讨氪激光周边虹膜成形术对药物治疗无效的原发性闭角型青光眼的有效性。方法 10眼原发性闭角型青光眼患者，其中8眼为急性发作，2眼为慢性闭角型青光眼，经检查确诊后立即给予局部和全身降眼压药物治疗，72 h后眼压仍不能下降至40 mm Hg时行氪激光周边虹膜成形术，观察治疗前及治疗后30 min、1 h、2 h、24 h的视力、角膜水肿、眼压及前房角变化。结果 氪激光周边虹膜成形术30 min后，眼压从42～71 mm Hg降至25～62 mm Hg，平均下降21.2%；术后1 h眼压为15～37 mm Hg，平均下降58.5%；术后2 h眼压为11～25 mm Hg，平均下降71.6%；术后24 h眼压为9～16 mm Hg，均降至正常，平均下降79.9%。激光治疗后患者不适症状迅速缓解，视力快速提高，角膜水肿消退，前房角有不同程度的加宽。结论 氪激光周边虹膜成形术能机械性拉开房角，迅速降低原发性闭角型青光眼的眼压，起效快，并发症少，是药物治疗无效青光眼的一种安全有效的方法。

【关键词】  氪激光；激光周边虹膜成形术；青光眼；眼压

    Krypton laser peripheral iridoplasty  as treatment for medically unresponsive  angle-closure glaucoma

    KANG Jie,FAN Gui-min.Department of Ophthalmology,The People’s Hospital of Hebei Province,Shijiazhuang 050051,China

    ［Abstract］  Objective  To evalute the intraocular pressure-lowering effects  of krypton laser peripheral iridoplasty for medically unresponsive primary angle-closure glaucoma.Methods  10 patients were included,8  were acute attack ,2 were chronic angle-closure glaucome .They were prescribed  topical and systemic IOP-lowering drugs.72 hours later,IOP is still above or equal 40 mm Hg.Visual acuity,corneal edema,IOP and the angle of anterior chamber were observed preoperatively and 30min,1 h,2 h,24 h postoperatively.Results  30 min after treatment,IOP decreased from 42～71 mm Hg to 25～52 mm Hg,21.2% decreased in average;1 h later,IOP were 15～37 mm Hg,58.5% decreased in average;2 h later,IOP were 11～25 mm Hg,71.6% decreased in average;24 h later,IOP were 9～16 mm Hg,79.9% decreased in average.After laser treatment, the uncomfortable symptoms were resolved quickly and visual acuity rose fasten with corneal edema dispeared and the anterior chamber-angle widened differently.Conclusion  Laser peripheral iridoplasty can mechanically open the anterior chamber angle and rapidly reduce the IOP of the primary angle-closure glaucoma with few complications.It is an effective and safety method for medically unresponsive glaucoma.

    ［Key words］  krypton laser;laser peripheral iridoplasty; glaucoma;intraocular pressure

    原发性急性闭角型青光眼的急性发作是眼科的急症之一，因为周边虹膜组织阻塞前房角导致急剧升高，导致眼痛、眼红、视力下降、头痛、恶心、呕吐等症状，应尽快开放前房角，降低眼压，挽救和保护视功能。传统的方法是应用全身和局部降眼压药物治疗，待眼压控制后行周边虹膜切除术或小梁切除术，但有一些患者使用足够的全身和局部降眼压药物后也不能使眼压下降。还有一些慢性闭角型青光眼患者虽然无明显临床症状，但其眼压经充分的药物治疗眼压仍居高不下。高眼压时间过长可导致不可逆的视功能损害，高眼压状态下的抗青光眼手术比眼处在安静状态下时危险大得多，更容易发生术中和术后并发症。笔者用氪激光周边虹膜成形术对药物治疗无效的原发性闭角型青光眼进行治疗，取得了较好的降眼压效果，现报告如下。

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