不同房角粘连范围原发性闭角型青光眼激光治疗疗效的初步报告

Evaluation of the effectiveness of laser therapy for primary angle closure glaucoma with different extent of goniosynechia

目的了解激光周边虹膜切开术或联合激光周边虹膜成形术对治疗不同房角粘连状态的原发性闭角型青光眼(PACG)患者的疗效。设计回顾性病例系列。研究对象PACG患者80例(128眼)。方法按房角不同状态分为3组:A组为房角未粘连关闭(37眼);B组为房角粘连关闭小于180°(61眼);C组为房角粘连关闭≥180°,但无明显青光眼性视神经病变(30眼)。全部患者行激光周边虹膜切开术,对于术后眼压仍>21mmHg或暗室试验阳性者,联合激光虹膜成形术治疗。术后随访1～4年。主要指标眼压、用药种类、视力。结果3组病例激光治疗前眼压为(15.5±5.23)mmHg,最后的随访眼压为(14.7±2.8)mmHg(t=2.167,P=0.032);激光治疗后青光眼降眼压用药明显减少(t=13.025,P=0.000)、前房角镜和UBM显示房角不同程度的变宽,激光虹膜切开术后暗室试验阳性者激光虹膜成形术后有91.8%转为阴性。结论本研究结果提示激光周边虹膜切开术或联合激光虹膜成形术不仅对房角粘连关闭小于180°的早期青光眼有效,对房角粘连大于或等于180°的PACG可能同样具有一定的疗效。今后需要前瞻性研究来进一步证实。

Objective To evaluate the effects of laser iridectomy or combined laser iridoplasty for patients of primary angle closure glaucoma （PACG） with different extent of goniosynechia. Design Retrospective case series. Participants 80 patients （128 eves）with PACG. Methods 128 eyes of 80 patients with PACG after laser iridectomy or combined laser iridoplasty were divided into 3 groups by different extent of goniosynechia. Group A, 37 eyes with no goniosynechia, group B, 61 eyes with goniosynechia less than 180°, and group C, 30 eyes with goniosynechia more than 180° without glaucomatous optic neuropathy. Followed-up ranged 1 to 4 years. Main Outcome Measures Intraocular pressure, medication score, visual acuity. Results The average intraocular pressure had significantly decreased from 15.5±5.23 mmHg before laser therapy to 14.7±2.8 mmHg in the final follow-up （t=2.167, P=0.032）. After laser therapy, medication score had significantly decreased （t=13.025, P=0.000）, the anterior chamber angle was widened detected by gonioseopy and UBM, the positive darkroom test became negative by 91.8%. Conclusions This study suggested laser theapy be effective not only to patients of early PACG with goniosynechia 〈 180°, but also be possibly effective in some degree for PACG patients with goniosynechia more than 180°. Further prospective studies are needed to confirm our view.