超声生物显微镜指导青光眼激光手术

Laser surgery for angle closure glaucoma under the guide of ultrasound biomicroscopy

目的了解利用超声生物显微镜(UBM)为早期闭角型青光眼选择激光手术的术式和评价疗效的意义。方法62例98眼早期原发性闭角型青光眼,按照UBM的检查结果分为两组:A组虹膜膨隆型,32例53眼,行Q开关Nd:YAG激光周边虹膜切除术;B组虹膜高褶型,30例45眼,行倍频Nd:YAG激光虹膜成形术。结果激光术后3个月,62例98眼的平均眼压从术前的(22.20±3.40)mmHg降到(17.50±1.80)mmHg(1mmHg=0.133kPa);平均用药指数从术前的(2.50±1.50)分降到(1.10±0.80)分;A组和B组小梁虹膜夹角较术前分别增加了7°和9°;房角开放距离(AOD500),分别增加130μm和155μm;晶状体虹膜角分别减少了9°和6°,虹膜悬韧带距离分别减少了24μm和13μm。差异均有统计学意义(P<0.01)。结论利用UBM为早期闭角型青光眼选择激光手术的术式和评价其疗效是准确可靠的。

Objective To evaluate ultrasound t）iomicroscopy （UBM） in laser surgery for early angle-closure glaucoma. Methods Ninety-eight eyes of 62 patients with primary angle closure glaucoma （PACG） enrolled in this study. They were divided into 2 groups by UBM. The group A, 53 eyes of 32 patients with iris bombe,underwent Q-switched Nd：YAG irideetomy and the group B,45 eyes of 30 patients with iris plateau ,underwent frequency Nd： YAG iridoplasty. Results At 3 month,the average lOP and medication score of 98 eyes had decreased to （ 17.50±1.80 ） mmHg and 1.10±0.85 from the baseline 22.20±3.40 mmHg and 2.50±1.50. Compared with pretreatent, the trabeeular iris angle and angle open distance （ AOD500 had increased by 7° and 9°, 130 μm and 155 μm respectively in the group A and B （P 〈0. 01 ,paired t test）. The lens iris angle and iris zonula distance decreased by 9° and 6°,24 μm and 13 μm,respectively （P 〈0. 01 ,pairedt test）. Conclusions Iridectomy and iridoplasty for PACG guided by UBM is accurate and reliable.