激光虹膜周边切除术治疗慢性闭角型青光眼的远期疗效

Long-term effectiveness of laser peripheral iridectomy on treatment of chronic angle-closure glaucoma

目的观察慢性闭角型青光眼患者接受激光虹膜周边切除术(LPI)治疗的远期效果。方法对长期随访的66例(116眼)接受LPI的慢性闭角型青光眼患者进行回顾性研究,观察术前及术后的患者情况。结果20眼(17%)术后未用药,眼压控制在<21 mmHg;49眼(42%)经药物控制眼压正常;47眼(41%)用药情况下,眼压>21 mmHg,其中35眼接受进一步手术治疗。以术前眼压21 mmHg为界将患眼分为2组。2组的LPI单独起作用者分别为17眼和3眼(χ2=6.136,P=0.013),青光眼失控者分别为15眼和32眼,差异有统计学意义(χ2=26.68,P<0.01)。结论对LPI术后慢性闭角型青光眼患者,尤其是术前眼压控制差的患者应密切随诊,以防止视功能进一步损害。

Objective Laser peripheral iridectomy was a common management for chronic angle-closure glaucoma in clinic,but its long-term effectiveness is below understood. This study was to evaluate the long-term effect of LPI on chronic angleclosure glaucoma. Methods The regular follow-up result of 116 eyes from 66 patients received laser peripheral iridectomy for chronic angle-closure glaucoma was retrospectively studied. The intraocular pressure （IOP） , optic disc change, chamber angle state,visual field, medicine history and further treatment before and after laser peripheral iridectomy were recorded and analysed. Results During the mean follow-up period of 73.2 months, IOP was 28.5 mmHg in the patients with only laser peripheral iridectomy and 23.5 mmHg in the patients with laser peripheral iridectomy ＋ medicine, respectively. After laser peripheral iridectomy,no more medicine treatment was needed in 20 eyes （17%） ,and 49 eyes （42%） showed a well-controlled IOP under the use of laser peripheral iridectomy ＋ medicine. IOP of 47 eyes （41%） was over 21 mmHg in the patients with laser peripheral iridectomy ＋ medicine. Further surgery was performed in 35 eyes, including trabeculeetomy in 30 eyes and laser peripheral iris plasty and selective laser trabeculoplasty in 5 eyes. The mean duration between laser peripheral iridectomy and further surgery was 18.66 months. Eyes cured only by LPI were 17 and 3 in IOP 〈 21 mmHg group and ≥ 21 mmHg group, showing a significant difference between them （χ^2 = 6. 136,P = 0.013 ）. Number of failure to surgery and medicine treatment was 15 eyes and 32 eyes, respectively（χ^2 = 26.68 ,P 〈 0. 001 ） at the end of follow-up. Conclusion Most of chronic angle-closure glaucoma patients need further treatment after laser peripheral iridectomy,and some even need trabeculectomy for control of fOP. So it is necessary for patients with chronic angle-closure glaucoma, especially those with high lOP, to visit doctor regularly.