联合激光手术对原发性闭角型青光眼的防治价值

Therapeutic and preventive value with combined laser surgery for primary angle-closure glaucoma （PACG）

目的评价联合激光手术对原发性闭角型青光眼（primary angle—closure glaucoma，PACG）的治疗和预防价值。方法对75例102眼PACG（治疗组）以及50例100眼PACG的高危人群（干预组），行联合激光手术治疗，包括激光周边虹膜切除术（laser peripheral iridectomy，LPI）或联合Argon激光周边虹膜成形术（Argon laser peripheral iridoplasty，ALPI）。术后随访（2～4）年。结果治疗组和干预组成功率均100％。202眼最终眼压21mmHg以下。所有患者周切孔通畅、前房角不同程度开放和增宽。最终的暗室加俯卧试验均阴性。治疗前后视力、视野、眼底C／D值无明显变化。治疗组无PACG急性发作。干预组无PACG发生。除有轻微前葡萄膜炎和短暂眼压升高反应外无其它严重并发症。结论联合激光手术安全有效，是治疗PACG的较好方法之一，并能有效地预防一定高危人群PACG发生。

Objective To evaluate the preventive and therapeutic value with combined laser surgery for primary angle-closure glaucoma （PACG）. Methods Seventy-five cases （102 eyes ） of PACG（therapeutic group） and fifty cases （100 eyes） of crowds with high degree danger （intervenient group） were treated with combined laser technique, including laser peripheral iridectomy （LPI） or argon laser peripheral iridoplasty （ALPI）. All cases were followed-up ranging from 2a to 4a postoperatively. Results It was demonstrated the successful rate in the therapeutic group and preventive group were 100%. the final IOP of 202 eyes were below 21mmHg. In all cases, iridectomy holes were clear and anterior chamber angle reopened and increased to various degrees. The dark room and prone test finally was negative in all cases. There were no significant changes of visual acuity, visual field and ocular fundus C/D between the pre and after treatment. There was no occurrence of acute attack of PACG in therapeutic group. There was no occurrence of PACG in intervenient group. There were no severe postoperative complications except slight anterior uveitis and increased transient IOP reaction. Conclusion The combined laser surgery is safe and effective. It is an deal method for the treatment of PACG. It can effectually prevent occurrence of PACG in definite crowds with high degree danger.