作者：朱凤云，马义宾 作者单位：泰安市中心医院眼科医院 山东 泰安 271000
【摘要】目的 评价NA:YAG激光虹膜切除术治疗原发性闭角型青光眼和葡萄膜炎继发青光眼的临床疗效。方法 回顾分析192例219眼原发性闭角型青光眼和9例葡萄膜炎继发青光眼，接受NA:YAG激光虹膜切除术后的临床效果，随诊16～46月。结果 激光切孔一次成功205眼（占89%），激光能量在11～17.1 mJ,67%病例在22～84 Mj，击射次数2～33次。葡萄膜炎继发青光眼9眼均二次激光后虹膜孔通畅。95.61%术后眼压正常，视野无变化，术后早期一过性眼压升高占34%，术中出血占36%，房角色素增加占47%，1例术后28月接受小量切除术，8例术后需配合使用降眼压药物控制眼压。结论 NA:YAG激光虹膜切除术是一种治疗闭角型青光眼的安全有效的方法。术前掌握适应症，把握手术时机，充分的术前准备是手术成功的关键。
【关键词】 激光；虹膜切除术；青光眼；葡萄膜炎
The clinical observation on NA:YAG laser Iridectomy for 201 angle-closure glaucoma
ZHU Feng-yun, MA Yi-bin
The Eye Hospital of Taian Central Hospital,Taian 271000,China
Abstract: Objective: To evaluate the clinical efficacy of Nd:YAG laser iridectomy for primary angle-closure glaucoma and angle-closure glaucoma secondary to uveitis. Methods: 219 eyes of 192 patients with primary angle-closure glaucoma and 9 cases with angle-closure glaucoma secondary to uveitis were treated by NA: YAG laser iridectomy, and the clinical effects were then retrospectively analyzed. All cases were followed up for 16～46 months. Results: 205 eyes (89%) got patent holes in iris after the initial treatment. The laser energy ranged from 11 to 171mJ in which 67% cases were at 22～84MJ and the number of burns ranged from 2 to 33. 9 cases secondary to uveitis all got patent holes after the second treatment. The intraocular pressure was controlled well in 95.61% of all eyes and the eyeshot was not changed. The increase of intraocular pressure appeared in 34% of patients in the early part. 36% of patients have hemorrhage symptoms in surgery and 47% of patients have the raise of pigment granule in angle. One patient had to undergo the traditional trabeculectomy after 28 months. Eight patients have to use drugs to manage the intraocular pressure . Conclusion: NA :YAG laser iridectomy is the effective and safe method for angle-closure glaucoma. Understanding the surgical indication,finding out the time of surgery and making the excellent preparation are the pivotal factors for the successful surgery.
Key word: laser；;iridectomy；glaucoma；uveitis
激光技术已成为眼科常用和重要的治疗手段，以其独特的优点弥补了传统疗法的不足。NA:YAG激光虹膜切除术治疗原发性闭角型青光眼和葡萄膜炎继发性青光眼，目的是解除瞳孔阻滞，术后房水经虹膜切孔自后房流入前房，后房压力降低，周边前房加深，房角开放，眼压下降。现将我院近4年来采用NA:YAG激光切除术治疗原发性闭角型青光眼临床前期、缓解期、间歇期和葡萄膜炎继发闭角型青光眼共201例进行回顾性分析，以探究其临床治疗的规律。
1 对象和方法
1.1 对象
2001年4月至2004年3月我院开展NA:YAG激光虹膜切除术201例228眼。其中，急性闭角型青光眼临床前期或先兆期164眼，间歇期13眼，慢性期6眼；慢性闭角型青光眼房角开放超过1/2圆周者17眼，不足1/2圆周者2眼；葡萄膜炎继发闭角型青光眼9眼。男51例，57眼；女150例，171眼，年龄22～82 岁，50～70岁者占73%。激光治疗前后查视力、眼压、眼底、房角及视野。
1.2 方法
原发性闭角型青光眼术前2 h滴0.5%噻吗心胺眼液一次，术前1 h滴1%毛果云香碱3-4次缩瞳。继发性闭角型青光眼术前局部及全身应用降眼压药物和皮质类固醇激素控制眼部炎症。术前5 min滴0.4%倍诺喜1次，放Abraham镜，NA:YAG眼用激光波长1064 nm,曝光时间11 ns,光斑30 μm,击射部位：原发性闭角型青光眼选在11点或1点鼻上或颞上中周部虹膜隐窝处。继发性闭角型青光眼选择虹膜彭隆最高点附近，与角膜内皮有一定距离处。虹膜穿透指征：虹膜被穿透后可见大量色素随房水由后房涌入前房，此后见虹膜孔（0.2 mm2）和晶体前囊，周边前房加深。术后一周内给予复方新霉素、双氯酚酸钠滴眼液，每日4次，0.5%噻吗心胺滴眼液 ，每日2次。慢性闭角型青光眼和急性闭角型青光眼缓解期、慢性期加用1%毛果云香碱滴眼液，每晚一次。
2 结 果
2.1 虹膜孔形成情况
228眼中一次虹膜切孔成功205眼，占89%，14眼因术中出血、色素颗粒和组织碎屑遮挡或角膜混浊影响激光聚焦，于2天后再次切孔成功。9眼因葡萄膜继发青光眼一次切孔成功，前后房交通。随诊中出现激光孔闭锁，又进行了第二次激光治疗，之后激光孔保持通畅。
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