眼科研究 2000年第2期第18卷 临床研究
作者：宋玉伟 连浩 徐文烽 戢红
单位：644000 四川省宜宾市第二人民医院眼科
关键词：准分子激光；原发性青光眼；手术
摘要 目的 探讨准分子激光治疗原发性青光眼的效果。方法 原发性青光眼57眼，其中50眼为开角型青光眼，7眼为闭角型青光眼，用ArF准分子激光行巩膜瓣下巩膜造瘘。结果 57眼术前平均眼压(33.23±18.45)mmHg，术后平均(15.23±6.45)mmHg。治疗前后眼压具有显著性差异(P＜0.001)。5眼闭角型青光眼术后眼压波动较大，其中2眼改行小梁切除术。术后视力保持或改善占87.7%，前房深度、视野及视杯无明显改变，无1例出现较严重的术后并发症。结论 准分子激光巩膜瓣下巩膜造瘘是一种治疗原发性开角型青光眼的行之有效的手术方法。
分类号 R 775.2
Clinical observation of primary glaucoma treated by excimer laser
Song Yuwei，Lian Hao，Xu Wenfeng，et al．
Department of Ophthalmology，the Second People’s Hospital of Yibin City，Sichan 644000
Abstract ObjectiveTo study the therapeutic effects of primary glaucoma treated by excimer laser．Methods57 eyes of primary glauco ma，in which 50 eyes were open-angle glaucoma，and 7 eyes were angle-closure glaucoma，were treated by sclerostomy under the scleral flap using NIDEK-EC 5 000 ArF excimer laser．ResultsThe average intraocular pressure of 57 eyes were (33.23±18.45) mmHg in 57 eyes preoperation， and were （15.23±6.45）mmHg postoperation．T he differences of pre- and post-operativ e intraocular pressures were statistically significant（P＜0.001)．The intraocular pressures of angle-closure glaucoma in 5 eyes were a bnormal，of which 2 eyes were retreated b y trabeculectomy．Visual acuity was tende d to be stabilized and improved， in 87.7% of the eyes treated with laser surgery． The anterior chamber depth，the visual field and the optic cup had no obvious changes．None of the cases showed serious postoperative complications．ConclusionSclerostomy under the scleral flap by excimer laser is an effective surgery for the treatment of primary open-angle glaucoma．
Key words excimer laser primary glaucoma operation
我们从1996年6月至1998年6月用准分子激光治疗原发性青光眼34人(57眼)，取得满意疗效，现报道如下。
1 资料与方法
1.1 一般资料
男29眼(18人)，女28眼(16人)，年龄18～71岁，平均40.9岁。房角检查按Scheie分类法，其中50眼为原发性开角型青光眼(primary open-angle glaucoma，POAG），7眼为原发性闭角型青光眼(primary angle-closure glaucoma，PACG）。全部病例均为经局部药物治疗眼压仍反复升高或难于坚持用药者；无手术禁忌证；患者自愿。
1.2 治疗方法 0.5%地卡因表面麻醉后，作颞上方穹隆为基底之结膜瓣，于结膜瓣及巩膜间放置0.4 mg／ml丝裂霉素4 min，作1／2厚边长4 mm三角形半层巩膜瓣，于内层巩膜瓣角巩膜缘处用NIDEK EC-5000型ArF准分子激光作2 mm×1 mm矩形切削。激光参数：切削率0.6 μm／scan，频率30 Hz。193 nm激光不能被水传导，在切开Schlemm管时有房水或血水混合物流出，此时用吸血海绵吸湿，继续切削至近小管组织及小梁附近时，可见前房水渗漏聚集，阻止激光进一步切削，此时停止操作，即可避免巩膜全层穿透，保留角巩膜缘残膜，巩膜瓣复位固定，术后滴用抗生素及糖皮质激素滴眼液。术后随访2～24个月，平均11.8个月。随访内容：视力、裂隙灯、眼底镜检、前房深度(NIDEK UP-1000型眼科A超)、视野(Goldman视野计)、眼压（NIDEK NT-1000气压眼压计)。
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