超声生物显微镜评价联合激光治疗急性原发性闭角型青光眼

Clinical evaluation on combined laser therapy of acute primary angle-closure glaucoma with ultrasound biomicroscope

目的观察激光周边虹膜成形术联合周边虹膜切除术在治疗初次发作的急性闭角型青光眼中的安全性和有效性。方法初次发作的急性闭角型青光眼患者67例70眼,诊断后立即行氪激光周边虹膜成形术同时或待角膜透明后行YAG激光周边虹膜切除术,观察激光治疗前后视力、眼压及超声生物显微镜监测下的房角开放度数变化。结果视力：术后24h92.85%的患眼视力提高2行以上;眼压：术前32～80mmHg（1kPa=7.5mmHg）,平均（42.5±18.5）mmHg,术后1h平均眼压（27.5±9.5）mmHg,术后4h平均眼压（20.2±6.7）mmHg;中央前房深度：术前平均（1.69±0.34）mm,术后平均（2.13±0.20）mm;房角开放情况：术前均1/2以上关闭,术后92.85%患眼（65/70）房角不同程度改善,以下方和颞侧增宽明显;平均房角开放度数：术前平均2.15°±0.17°,术后6.23°±0.26°。激光术后各时间点眼压及术后超声生物显微镜下的房角开放度数、前房深度与术前比较差异均有统计学意义（P〈0.05）。结论氪激光周边虹膜成形术联合YAG激光周边虹膜切除术是急性闭角型青光眼早期快速降眼压的一种安全有效的方法。

Objective To evaluate the effect and safety of combined application of kr-laser peripheral iridoplasty（kr-LPI） and YAG-laser peripheral iridectomy（YAG-LPI） in patients with acute angle-closure glaucoma（AACG） using ultrasound biomicroscope （UBM）.Methods Seventy eyes of 67 patients with AACG were undertaken kr-LPI immediately,and the YAG-LPI was taken at the same time or after corneal transparent.The examination of intraocular pressure （IOP） by tonometer,anterior chamber angle by UBM and visual acuity were taken,and the data were compared before and after the operation.Results Visual acuity：The symptoms in 92.85% of patients were improved and visual acuity was increased 2 lines after 24 hours;IOP：Compared with pre-treatment,IOP was significantly （P〈0.05） decreased from （42.5±18.5） mmHg （32～80 mmHg,1 kPa=7.5 mmHg） to （27.5±9.5） mmHg at 1 hour,to （20.2±6.7） mmHg at 4 hours; Anterior chamber：Anterior chamber was significantly （P〈0.05） deepened （2.13±0.20） mm after Nd：YAG LPI compared with before LPI （1.69±0.34） mm;Anterior chamber angle ：UBM examination showed that the anterior chamber angle was significantly widened from 2.15°±0.17°（pre-LPI） to 6.23°±0.26°（post-LPI）.Conclusion Combined application of kr-LPI with YAG-LPI is an effective and safe method to manage acute attack of PACG.