Nd:YAG激光周边虹膜切除术治疗闭角型青光眼

Nd:YAG laser peripheral iridectomy for angle-closure glaucoma

目的观察Nd:YAG激光周边虹膜切除术治疗闭角型青光眼的临床疗效。方法对闭角型青光眼患者38例(47眼)行Nd:YAG激光周边虹膜切除术,分别于术后3d、1周、1个月、3个月、6个月、12个月观察虹膜穿孔情况、视力、眼压、前房深度,并于术后3个月、6个月、12个月复查视野。结果47眼术前平均眼压(21.38±8.02)mmHg(1kPa=7.5mmHg),术后3d、1周、1个月、3个月、6个月、12个月眼压均值分别为(24.22±5.26)mmHg、(17.33±6.23)mmHg、(16.95±3.75)mmHg、(16.50±3.23)mmHg、(16.35±2.32)mmHg、(15.82±1.80)mmHg,激光周边虹膜切除术后平均眼压与术前比较,差异均有统计学意义(均为P<0.01)。术前周边前房深度均≤1/3CT,术后均>1/3CT。激光周边虹膜切除术后各时间点视力与术前比较差异无统计学意义(均为P>0.05)。11眼术前视野检查有视野损害,36眼视野正常。术后3个月视野检查3眼视野损害减轻,8眼无变化;术后6个月视野检查5眼视野损害减轻或消失,6眼无变化;术后12个月视野检查7眼视野损害减轻或消失,3眼无变化,1眼视野损害进展。结论Nd:YAG激光周边虹膜切除术治疗闭角型青光眼疗效确切,并发症少,值得临床推广应用。

Objective To investigate the clinical efficacy of Nd：YAG laser peripheral iridectomy for patients with angle-closure glaucoma.Methods A total of 38 cases（47 eyes）with angle-closure glaucoma were taken Nd：YAG laser peripheral iridectomy.Iridal perforation,visual acuity,intraocular pressure（IOP）and depth of anterior chamber were observed at postoperative 3 days,1 week,1 month,3 months,6 months and 12 months,respectively,and visual field was rechecked at postoperative 3 months,6 months and 12 months, respectively. Results The average IOP were （ 21.38±8.02）mmHg（ 1 kPa = 7.5 mmHg）, （ 24.22 ± 5.26 ） mmHg, （ 17.33 ±6.23 ） mmHg, （ 16.95± 3.75 ） mmHg, （ 16.50 ± 3.23 ） mmHg, （ 16.35± 2.32 ） mmHg and （ 15.82±1.80 ） nmlHg at preoperation, postoperative 3 days, 1 week, 1 month, 3 months, 6 months and 12 months, respectively. There was statistical difference in average IOP among different times after laser peripheral iridectomy（ all P 〈 0.01 ）. Depth of peripheral anterior chamber was or less than 1/3 CT preoperatively, and more than 1/3 CT postoperatively. There was no statistical difference in visual acuity among different times after laser peripheral iridectomy compared with that preoperatively（ all P 〉 0.05 ）. With perimetry, there were 11 eyes with visual field damage and 36 eyes with normal visual field preoperatively; Visual field damage of 3 eyes lessened and 8 eyes without any changes at postoperative 3 months ;Visual field damage of 5 eyes lessened or disappeared and 6 eyes without any changes at postoperative 6 months ;Visual field damage of 7 eyes lessened or disappeared ,3 eyes without any changes and 1 eye progressed at postoperative 12 months. Conclusions Nd：YAG laser peripheral iridectomy for angle-closure glaucoma is with exact curative effects and few complications, and needs to be popularized.