【摘要】 目的: YAG激光周边虹膜切除术治疗闭角型青光眼的疗效及并发症的临床观察。
方法:本组病例20例（25眼)，诊断为闭角型青光眼临床前期、前驱期的22眼，3眼为间歇期。使用Nd：YAG激光机在虹膜中周部单脉冲击射均为一次透切成功，随访3～12mo，观察疗效及并发症。
结果:25眼激光切孔1次手术成功率100%。术后均出现了虹膜炎性反应，1～3h内一过性眼压升高5眼，前房出血4眼，角膜内皮损伤1眼，全部并发症于术后1～3d消失。无切孔后晶状体混浊及孔洞闭塞并发症发生。术后周边前房及房角增宽，眼压<18mmHg。
结论:Nd：YAG激光周边虹膜切除术治疗闭角型青光眼安全有效，对早期患者效果更佳，适宜在基层医院推广。
【关键词】 激光 虹膜周边切除 闭角型青光眼
Clinical observation on laser peripheral iridectomy treatment for early stage angleclosure glaucoma
XianHua Li, Rui Zheng, YiWei Feng
Department of Ophthalmology, Beijing Daxing District Hongxing Hospital, Beijing 100076, China
Abstract
AIM: Clinical observation on laser pheripheral iridectomy treatment for angleclosure glaucoma and the complications.
METHODS: Twenty patients (25 eyes) were diagnosed by angleclosure glaucoma, of them, 22 eyes was at early clinical stage and 3 eyes at intermittent stage. Nd: YAG laser singe pulse launch was performed on the middle of iris periphery. Followingup time was for 312 months, and the clinical effect and complications were observed.
RESULTS: All 25 eyes was finished in one time (success rate 100%). Iris inflammation reaction was found in all the patients after operation, in which 5 eyes rose the intraocular pressure (IOP) within 13 hours, 4 eyes were presented anterior chamber bleeding, and 1 eye had epithelial damage in the cornea. All the complications disappeared within 13 days. The complications such as crystalline turbid, hole obstruction were not found. Peripheral anterior chamber and chamber anger were got wide and IOP<18mmHg.
CONCLUSION: Nd: YAG laser peripheral iridectomy is a safe and effective method to treat angleclosure glaucoma, especially for the patients at early stage. It is suitable for primary hospitals.
KEYWORDS: laser; peripheral iridectomy; angleclosure glaucoma
0引言
青光眼是我国目前主要致盲性眼病之一，在盲人群中调查，其中20%为青光眼所致，失明后不能复明。我国闭角型青光眼占青光眼病例的79.60%～86.13%[1]，以老年人发病居多。随着社会逐渐进入老龄化，闭角型青光眼会进一步增多，而且病情复杂，提高青光眼治愈率，降低治盲率，是眼科医生研究和努力的目标。随着科学技术和设备仪器的发展，青光眼的治疗也有了新的飞跃。激光虹膜周边切除术在治疗瞳孔阻滞型闭角型青光眼有着很好的疗效。我院200701/200806用Nd:YAG激光机治疗早期闭角型青光眼，取得了明显的效果，现总结报告如下。
1对象和方法
1.1对象 闭角型青光眼患者20例(25眼)，男5例(5眼)，女15例(20眼),年龄57～76(平均67.5)岁,其中22眼是在闭角型青光眼的临床前期和前驱期，3眼在间歇期。7例(11眼)是在社区眼病普查中发现并进行治疗的。术前常规检查：视力、眼压、眼底、前房角、视野。术前眼压<21mmHg,周边前房<1/3CT，眼底C/D≤0.5，无明显的视野缺损。设备:选用进口澳大利亚产的Super Q型铷钇铝石榴石Nd:YAG激光眼科治疗机，Q开关，输出波长1064nm，双光点交叉光束瞄准聚焦，脉宽4ns，能量选择0.3～10mJ连续可变，治疗光束的焦点可调到瞄准光束焦点后0～250μm。
1.2方法 术前1h滴10g/L毛果芸香碱眼药水3～4次，使瞳孔充分缩小，虹膜平展。激光切除位置选择在虹膜中周部10∶00、11∶00、1∶00、2∶00、5∶00、7∶00的虹膜隐窝处，根据虹膜的颜色和组织的疏松情况选择能量在6.0～8.2mJ（本组病例无碳黑虹膜），将治疗光束的焦点调至瞄准光束焦点后150～250μm，聚焦准确后单脉冲击射，全层穿透，可见色素房水涌入前房，周边部前房即时加深，虹膜膨隆缓解，激光孔一般≥300μm。如果激光孔小或未击透条件允许可再次击射，如果前房内大量颗粒悬浮或击射部位出血影响聚焦可暂停2～3d后再治疗。术后5g/L马来酸噻吗洛尔眼药水滴眼1次；10g/L醋酸泼尼松龙眼药水滴眼5分钟1次，共6次，以后6次/d；1g/L双氯酚酸钠眼药水4次/d,持续5～7d,以减轻术后反应。术后1～3h测眼压，如果眼压高（>22mmHg），局部加滴10g/L毛果芸香碱眼药水，或口服乙酰唑胺0.25～0.5g。出现前房出血时轻压眼球，停止操作。术后1,3,7d复诊，记录视力、眼压、前房反应、前房深度及房角的变化、激光孔是否通畅。3mo复查时增加视野及眼底的检查。
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