激光周边虹膜成形术对急性闭角型青光眼发作期角膜内皮细胞的影响

Effects of laser peripheral iridoplasty on corneal endothelial cells of acute attack of primary angle-closure glaucoma

目的：研究激光周边虹膜成形术（ LPI）对急性发作期闭角型青光眼角膜内皮细胞的影响。方法回顾性系列病例研究。对2005年9月至2007年9月确诊的原发性闭角型青光眼急性发作期患者180例（180只眼）分为药物组及治疗组，药物组应用降眼压药物联合LPI，治疗组及时行LPI边虹膜成形术，术后1～2 d、1个月观察患者角膜内皮细胞情况。采用配对t检验的方法分别比较药物组和治疗组术后1～2d和术后1个月发作眼和对侧眼角膜内皮细胞密度差异采用配对t检验；药物组与治疗组治疗1个月后，发作眼角膜内皮细胞密度的比较采用t检验。结果治疗后1～2 d：药物组发作眼角膜内皮细胞密度为（2406．30±586．45）个/mm2，对侧眼角膜内皮细胞密度为（2623．49±446．01）个/mm2，差异有统计学意义（t＝-2．223，P＜0．05）；治疗组发作眼角膜内皮细胞密度为（2461．33±636．82）个/mm2，对侧眼角膜内皮细胞密度为（2553．88±515．22）个/mm2，差异无统计学意义（t＝-1．059，P＞0．05）；治疗后1个月：药物组发作眼角膜内皮细胞密度为（2450．93±639．27）个/mm2，对侧眼角膜内皮细胞密度为（2621．13±469．43）个/mm2，差异无统计学意义（t＝-1．778，P＞0．05）；治疗组发作眼角膜内皮细胞密度为（2401．34±617．76）个/mm2，对侧眼角膜内皮细胞密度为（2613．66±460．61）个/mm2，差异有统计学意义（t＝-2．822，P＜0．05）；治疗1个月时药物组与治疗组发作眼角膜内皮细胞密度与眼压下降后1～2d时的发作眼角膜内皮细胞密度变化比较，药物组角膜内皮细胞密度减少（43±412．55）个/mm2，治疗组角膜内皮细胞密度减少（80．96±537．09）个/mm2，差异无统计学意义（t＝-0．533，P＞0．05）。结论 LPI对角膜内皮细胞的无明显损害，是闭角型青光眼急性发作期的安全治疗方法之一。

Objective To study effects of laser peripheral iridoplasty( LPI) on corneal endothelial cells of acute attack of primary angle-closure glaucoma ( PACG).Methods Retrospective study of 180 patients (180 eyes) acute attack of primary angle-closure glaucoma that were diagnosed from 09, 2005 to 09, 2007 were devided into two groups.The drop group was therapied hypotensive drugs combined.The therapy group was therapied by laser peripheral iridoplasty.Corneal endothelial cells were observed at postoperative 1-2 days, 1 month.The method using a paired t-test were compared medication and treatment groups after 1 to 2 days and one month, onset eye and the contralateral eye corneal endothelial cell density and whether the differences were statistically significant.Drop group and the treatment group a month after the onset eye corneal endothelial cell density compared using the t-test approach.Restults 1-2 days after treatment:drug group onset eye corneal endothelial cell density (2406.30±586.45) a/mm2, contralateral eye corneal endothelial cell density (2623.49±446.01)a/mm2, There were significant difference between their (t=-2.223, P<0.05).Therapy group onset eye corneal endothelial cell density (2461.33 ± 636.82)a/mm2, contralateral eye corneal endothelial cell density (2553.88 ±515.22) a/mm2, no statistically significant difference between their (t=-1.059, P>0.05);1 month after treatment:drug group onset eye corneal endothelial cell density (2450.93±639.27)a/mm2, contralateral eye corneal endothelial cell density (2621.13±469.43)a/mm2, no statistically significant difference between the two (t=-1.778, P>0.05); Treatment group onset eye corneal endothelial cell density (2401.34 ±617.76)a/mm2, contralateral eye corneal endothelial cell density (2613.66±460.61)a/mm2, there was significant difference between the two(t=-2.822, P<0.05);1 month of treatment, drug and therapy groups onset eye corneal endothelial cell density and decrease in IOP after 1-2 days, the onset eye of corneal endothelial cell density compared, Drug group corneal endothelial cell density decreased ( 43 ±412.55) a/mm2 , therapy group corneal endothelial cell density decreased (80.96±537.09)a/mm2, the differences between the two groups was not statistically significant (t=-0.533, P>0.05).Conclusion Laser peripheral iridoplasty was without obvious injuries of corneal endothelial cells for acute attack of PACG and it was a safe approach for acute attack of PACG.