氩激光周边虹膜成形术治疗急性闭角型青光眼随访研究

Follow-up study for immediate argon laser peripheral iridoplasty as the treatment for acute attack of primary angle closure glaucoma

目的：观察氩激光周边虹膜成形术在原发性闭角型青光眼急性发作期的作用,评价该治疗方法随访1a疗效的稳定性。方法：原发性闭角型青光眼第1次急性发作患者23例（23眼）,局部予以10g/L毛果芸香碱滴眼液及5g/L噻吗心安滴眼液各1滴后,行氩激光周边虹膜成形术,眼压控制稳定后5～7d行激光周边虹膜切开术。观察氩激光周边虹膜成形术治疗前及治疗后2h;1,3,6,9,12mo眼压变化;观察相应时间点房角变化;术后1,3,6,9,12mo行暗室加俯卧激发试验。结果：氩激光周边虹膜成形术前平均眼压为69.43±8.22mmHg,术后2h眼压为15.74±3.09mmHg,随访期间患者未发生高眼压;术前所有23眼前房角镜检查可见前房角关闭,术后2h所有23眼静态前房角镜检查前房角增宽,小梁网可见范围增宽,随访期间各方房角无明显变化;所有患者术后1,3,6,9,12mo行暗室加俯卧激发试验均为阴性。结论：氩激光周边虹膜成形术治疗原发性闭角型青光眼急性发作期（不联合使用全身降眼压药物治疗）可迅速、有效、安全降低眼压,重新开放房角,随访1a疗效稳定。

AIM： To study the efficacy, safety and persistency of argon laser peripheral iridoplasty （ALPI） as a first-line treatment for acute primary angle-closure glaucoma （PACG）. METHODS： Twenty-three cases （23 eyes） with acute PACG were recruited into the study, Each of them received topical pilocarpine （ 1% ）, timolol （0.5% ）, and immediate ALPI as primary treatment. The intraocular pressure （IOP） of 2 hours, 1, 3, 6, 9 and 12 months after surgery were documented, The angle of anterior chamber was observed at each follow-up time. Dark room and prone provocative tests were done at 1, 3, 6, 9 and 12 months after surgery, RESULTS： The mean IOP of 23 eyes was reduced from 69.43± 8.22mmHg, before ALPI, to 15.74 ±3.09mmHg at2 hours after surgery. All eyes did not have ocular hypertension during the follow-up time. Compared with the closure of anterior chamber angle before ALPI, it was widened after surgery under goniscope and the trabecular meshwork was visualized widely in static state. The results of dark room and prone provocative tests were negative at 1,3, 6, 9 and 12 months after surgery. CONCLUSION： Argon laser peripheral iridoplasty, without adjunctive systemic carbonic anhydrase inhibitors and hyperosmotic agents, appears to be effective and safe in controlling the IOP in acute PACG, efficacy is persistent during the follow-up time.