激光周边虹膜成形术治疗闭角青光眼的中远期结果

Laser peripheral iridoplasty in the management of angle-closure glaucoma： An eighteen months follow-up study

目的探讨激光周边虹膜成形术治疗闭角青光眼的中远期效果。方法对UBM显示虹膜根贴靠小梁网的早期闭角青光眼55只眼，实施倍频Nd：YAG（532nm）激光周边虹膜成形术。激光治疗参数：功率300—500mW，暴光时间0．2～0．3s，光斑直径500μm，距虹膜根部500μm在360°范围做24～30个光凝点。术后定期复查视力、眼压、前房角，记录用药指数，并做UBM。结果激光术后随访（11-39）月（18．6±6．2）月。与术前相比，术后眼压下降均非常显著（F=45．454，P=0．000），用药次数显著减少（肚48．715，P=0．000），AOD500增大亦非常显著（F=46．567，P=0．000）。术后1、2、3年房角开放度回退到术前情况的眼数分别约为12％，26％，55％（X2=11．772，P=0．003）。结论LPI术后随时间的推移，闭角青光眼前房角开放度逐渐回缩，降眼压效果也逐渐减弱。

Objective To explore the long-term outcome of laser peripheral iridoplasty （LPI） in the management of angle-closure glaucoma. Methods A total of 55 LPI procedures were performed on the consecutive 55 eyes with early angle-closure glaucoma and their iris root closed to trabecular meshwork showed by ultrasound biomicroscopy （UBM）. A double-frequency Nd：YAG was used in LPI and laser parameter was 300-500 mW power, 0.2--0.3 second duration, 500 μm spot size, 24-30 burns over 360 degree. Patients were regularly assessed for postoperative visual acuity, intraocular pressure, medication score, gonioscopy, and UBM. Results The mean follow-up was 18.6± 6.2 months （ranged 11-39 months）. Comparing with preoperation, postoperative average IOP decreased significantly （F=45.454, P=0.000）, medication score re- duced significantly （F=48.715, P=0.000）, AOD500 increased significantly （F=46.567, P=0.000 ）. Angle open degree retumed to the baseline was 12%, 26%, 55%, respectively at 1, 2, 3 year postoperatively （X2 =11.772, P=0.003）. Conclusions With elapse of time after LPI, angle open degree of angle-closure glaucoma returned to baseline gradually, and effect of depressing IOP weakened.