【摘要】 目的：了解毛果芸香碱是否能有效降低棕色虹膜人种激光虹膜切除术后眼压急性升高。方法：原发性闭角型青光眼48例58眼，按年龄、性别进行匹配，分为治疗组和对照组。治疗组术前30min和术后即刻滴用20g/L毛果芸香碱，对照组滴用安慰剂。术后0.5,1.0,1.5,2.0,3.5h观察眼压和其他情况。结果：激光治疗后，治疗组和对照组眼压最大升高值分别为0.62±0.67kPa(1kPa=7.5mmHg)和1.13±0.87kPa，两组间差异有显著性(P=0.03)。治疗组的眼压明显下降发生于Nd∶YAG激光虹膜切除术后0.5,1.0和1.5h。除治疗组激光虹膜切除术后瞳孔直径明显小于对照组外，未见其他眼部和全身的副作用。结论：20g/L毛果芸香碱在棕色人种中可以有效地防止Nd∶YAG激光虹膜切除术后眼压升高。
【关键词】 青光眼;闭角型;激光手术;毛果芸香碱
Increase of intraocular pressure after Nd∶YAG laser iridectomy interruped by pilocarpine
ChunYan Wang,YuDe Ai, GeTu Tao
Department of Ophthalmology, the Affiliated Hospital of Inner Mongolia Medical College, Hohhot 010050,Inner Mongolia Autonomous Region,China
AbstractAIM: To investigate if pilocarpine can effectively prevent the acute increase of intraocular pressure (IOP) in brown eyes after Nd∶YAG laser iridectomy.METHODS: Totally 48 cases 58 eyes with primary angleclosure glaucoma were divided into treatment and control groups, which were matched by age and sex. One drop of pilocarpine was applied into the conjunctival sac at one hour before laser iridectomy and immediately after laser iridectomy in treatment group, whereas one drop of antibiotic as placebo was applied in control group at the same time. IOP, pupil diameter were measured at 0.5, 1.0, 1.5, 2.0, 3.5 hours after laser iridectomy.RESULTS: The maximum increase of IOP after laser iridectomy was 0.62±0.67kPa and 1.13±0.87kPa in treatment and control group respectively, there was a significant difference (P=0.03). The obvious decrease of IOP occurred at 0.5, 1.0 and 1.5 hours after laser iridectomy in treatment group. No ocular and systemic side effects were found in treatment group, except pupil diameter was obviously larger in treatment group than that in control group.CONCLUSION: 20g/L pilocarpine can effectively prevent the acute increase of IOP in brown eyes after Nd∶YAG laser iridectomy.
KEYWORDS:glaucoma; angleclosure; laser surgery; pilocarpine
0引言
Nd∶YAG激光虹膜切除术是治疗瞳孔阻滞型原发性闭角型青光眼的有效方法。由于其操作方便，无论在浅色还是深色虹膜的患者中均有良好的效果，临床上已普遍应用。但是眼压急剧升高是激光虹膜切除术后常见的并发症[13]，这对视神经已有损伤的青光眼患者的视功能是一个严重威胁。一些学者已使用各种降眼压药物防止激光虹膜切除术后急性眼压升高，但效果不一致[4]。我们由于临床和经济条件所限，希望找寻一种廉价而有效的药物能防止激光虹膜切除术、激光晶状体后囊膜切开术后眼压升高。所以我们在一组Nd∶YAG激光虹膜切除术的患者中滴用了20g/L毛果芸香碱，以便进行有效性研究，了解这种药物对棕色虹膜的人是否具有防止Nd∶YAG激光虹膜切除术后急性眼压升高的作用。
1对象和方法
1.1对象 选取200804/200910在本院眼科门诊进行Nd∶YAG激光虹膜切除术的原发性闭角型青光眼患者48例58眼进行本试验。凡有以下情况者除外：眼部有活动性炎症者，严重的心血管病者，眼部或全身情况不允许用Perkins手持压平眼压计测量眼压者。按患者的性别和年龄进行匹配，将选择的患眼分成治疗和对照两组。如果患者双眼进行Nd∶YAG激光虹膜切除术，则任选1眼进入治疗组，另1眼进入对照组。 表1两组术前的一般情况比较表2两组激光治疗前、后眼压比较表3两组术后眼压升高的眼数比较眼
1.2方法 Nd∶YAG激光虹膜切除术应用LUX公司生产的Nd∶YAG激光器进行。治疗组：于Nd∶YAG激光虹膜切除术前30min和激光治疗后即刻滴用20g/L毛果芸香碱眼液各1滴。对照组：于相同时间滴用抗生素眼液作为安慰剂。所有患者和执行激光治疗者均不知患眼分组和用药情况。治疗前询问和记录患眼使用抗青光眼药物情况。治疗组和对照组中，各有13眼滴用20g/L毛果芸香碱，4眼合并滴用20g/L毛果芸香碱和5g/L噻吗心安或10g/L美开朗。所有进入本试验的眼，激光治疗前、后所用的抗青光眼药物不变。激光治疗后1h内，滴用10g/L典必殊1次，以后4次/d。Nd∶YAG激光治疗前1h，术前即刻，术后0.5,1.0,1.5,2.0,3.5h测量眼压、瞳孔直径、睑裂高度。用Perkins手持压平眼压计测量眼压，并以相同时间间隔测量血压。记录用药后可能出现的副作用，如头痛，出汗，流泪眼周痛、结膜苍白、眼睑后退等。
统计学分析：采用SPSS 11.5软件包，应用t检验对治疗组和对照组激光治疗前后的眼压、瞳孔直径、睑裂高度进行比较，应用χ2检验比较治疗组和对照组术后眼压升高的程度，以P<0.05为有统计学意义。
2结果
2.1治疗组和对照组的一般情况 两组一般情况见表1。术前眼压、瞳孔直径、睑裂高度及Nd∶YAG激光虹膜切除术所用的总能量和脉冲次数两组间差异均无显著性。
2.2治疗组和对照组Nd∶YAG激光虹膜切除术前后眼压的改变 治疗组激光治疗后眼压最大升高值为0.63±0.67kPa(1kPa=7.5mmHg)，对照组为1.13±0.87 kPa，两组间差异有显著性(t检验，P=0.03，表2)。激光治疗后0.5,1.0,1.5h后治疗组的眼压明显低于对照组，治疗组的眼压高峰显著降低,并持续术后3h以上。
2.3治疗组和对照组各观察时间眼压值 在术后1.0,1.5h，治疗组眼压比术前升高>0.67kPa的眼数明显减少见表3。
2.4激光治疗后治疗组和对照组的瞳孔直径和睑裂高度的比较 治疗组和对照组激光治疗后最大瞳孔直径改变分别为0.31±0.52mm和0.05±0.36mm，两者相比，差异有非常显著性(P=0.01)。治疗组和对照组激光治疗后最大睑裂改变分别是1.1±1.3 mm和0.6±1.5 mm，两者相比，差异无显著性(P=0.19)。
2.5其他情况 滴用20g/L毛果芸香碱后，血压变化无统计学意义，无眼周痛、眼压升高、胸闷、结膜苍白、眼睑后退等副作用。
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