慢性闭角型青光眼激光虹膜周边切除术远期临床疗效分析

A clinical observation of the long-term effect of Nd:YAG laser iridectomy for chronic angle closure glaucoma

目的 观察各期慢性闭角型青光眼(慢闭青) ,在施行YAG激光虹膜周边切除术(YAG laser iridecto-my,YL I)治疗后的远期临床效果并评估其适用范围。方法 对青光眼门诊中已施行YL I的各期慢闭青患者随访一年以上者(1～8年,平均3年) ,着重对眼压的控制情况、视功能(视力和杯盘比)的保持情况、激光孔的保持情况、周边房角的保持情况、以及远期合并症等方面进行观察分析。结果 在2 0 4例(337只眼)各期慢闭青中,YL I后有87.5 % (2 95 /337)的眼压及视功能保持稳定。其中2 7% (91/337)临床前期或早期病人效果最佳,基本达到“痊愈”;而6 0 .5 % (2 0 4 /337)的发展期或晚期病人则需长期加点适量降眼压药方可控制眼压。另外有12 .5 % (42 /337)的发展期或晚期病人,眼压仍未能控制,需用其它治疗或施行手术。结论 Nd:YAG激光虹膜周切术,对慢闭青是一种简便而有效的治疗手段,尤其对临床前期或早期患者效果最佳;对很大一部分发展期或晚期病人,施行YL I后加点药可以控制眼压,从而避免了手术。

Objective To observe the long-term effects of Nd:YAG laser iridectomy for the treatemnt of different stages of chronic angle closure glaucoma and to assessed the scope of its indications. Methods Randomly selected the patients who have performed YLI for more than one year average 3 years in out patients of glaucoma. The observation were stress to that the controlling of IOP, the maintenance of visual function, the maintenance of laser orifices ,the peripheral chamber angle , and the long-term complications. Result in 204 cases 337 eyes of various stages of chronic angle closure glaucoma after YLI treatment ,there were 87.5%(295/337) of eyes the IOP and visual functions keep stable , in which 27%(91/337) pre-clinical or carly stage patients get extremely good results achieved 'radial cure', whereas ,the 60.5%(204/337) of advance or late stage patients have to added some local administration of antiglaucoma drops. There were 12.5%(42/337) eyes of advance or late stages patients the IOP still not controlled satisfactory needed to take another therapy or performed surgical interference. Conclusions YAG laser iridectomy is a simple and effective means for treatment of chronic angle closure glaucoma especially for early stage patients , about 60.5% of advance or late stage patients need to added some antiglaucoma drops in long-term, but they can be escape for surgery.