非穿透小梁手术后Nd:YAG激光房角穿孔术疗效观察

Clinical results of Neodymium:YAG laser goniopuncture after deep sclerectomy

目的观察和评价非穿透小梁手术(NPTS)后YAG激光房角穿孔术(LGP)的降眼压效果及并发症。设计回顾性病例系列。研究对象 NPTS术后行LGP的23例(27眼)青光眼患者。方法对NPTS术后早期高眼压的23例(27眼)青光眼患者行LGP,观察术眼LGP术前、术后早期和术后远期的眼压,及术后并发症。主要指标眼压,并发症。结果 NPTS术后平均(11．4± 15.6)周行LGP,LGP后平均随访(15．87±14．68)周。LGP术前平均眼压为(19．7±5．09)mmHg,术后早期平均眼压为(10．8±3．7) mmHg(P=0．011)。平均降眼压幅度为8．9mmHg(45．2％)。其中随访时间在4个月以上者16眼,术前平均眼压(19．2±3．9)mmHg,术后早期平均眼压(11.9±3．6)mmHg,术后中远期平均眼压(15．7±2．9)mmHg(P=0．000)。术后远期眼压较术前下降3．5mmHg (17．8％)。并发症有虹膜嵌顿、术后低眼压、虹膜周边前粘连等。结论 LGP是NPTS术的有效补充,它提高了NPTS术的远期手术成功率,是一种安全有效的治疗措施。

Objective To observe and evaluate the intraocular pressure （IOP） lowering effect and complications of laser goniopuncture（LGP） after non-penetrating trabeculectomy（NPTS）. Design A retrospective case series study. Participants 23 patients （27 eyes ） with glaucoma who had LGP after NPTS. Methods IOP before laser, at early stage and at late stage after laser were recorded and compared. Main Outcome Measures Intraocular pressure and the complications. Results The average follow-up time was 15.87±14.68 weeks, and the time between NPTS and laser was 11.4±15.6 weeks. Among all 27 eyes, average IOP before laser was 19.7±5.09mmHg; average IOP at early stage after laser was 10.8±3.7mmHg. There was significant difference （P=0.011 ）. IOP decreased 45.2%. Among 16 eyes, which were followed-up at least 4 months, average IOP before laser was 19.2±3.9mmHg, average IOP at early stage and at late stage after laser were 11.9±3.6mmHg and 15.7±2.9mmHg respectively. There was significant difference（P=0.000） too. lOP decreased 17.8%. Complications include iris prolapse, hypotony, and peripheral anterior synechia of iris. Conclusion LGP is a safe and effective supplementary treatment for NPTS. It increases the successful rate of NPTS in terms of IOP lowering.