前房穿刺术与激光周边虹膜成形术治疗闭角型青光眼急性发作观察

Observe the clinical effect of acute attack of primary angle-closure glaucoma treated by paracentesis of anterior chamber and laser peripheral iridoplasty

目的 评价前房穿刺术（ACP）与激光周边虹膜成形术（LPI）治疗原发性闭角型青光眼急性发作的实用性和安全性.方法 对52例55只眼确诊为原发性闭角型青光眼首次急性发作患者随机分为ACP组26例27只眼和LPI组26例28只眼,观察治疗后眼压下降情况及眼压下降至21 mm Hg（l mm Hg=0.133 kPa）所用时间、房角开放情况和并发症.结果 治疗后0.5 h、lh、2h、3h、4h、6h、12 h眼压,ACP组分别为：（12.7±3.4） mm Hg、（13.6±5.8） mm Hg、（14.2±4.4） mm Hg、（19.6±5.2） mm Hg、（18.3±4.5） mm Hg、（19.7±3.1） mm Hg、（17.5±5.6） mm Hg.LPI组分别为（44.3±4.2） mm Hg、（35.6±4.7） mm Hg、（24.3±5.2） mm Hg、（21.2±4.3） mm Hg、（19.5±3.2）mm Hg、（20.1±2.7） mm Hg、（18.6±4.8）mm Hg.治疗后0.5 h、lh、2h组间比较差异具有统计学意义（t =30.601,15.482,7.762；P＜0.01）.房角开放范围大于180°ACP组为81.5％,LPI组85.7％,组间比较差异无统计学意义（x2=0.559,P＞0.05）.主要并发症有前房内炎症反应和睫状体脉络膜脱离,无眼内感染和脉络膜下暴发性出血等严重并发症.结论 LPI降低AACG急性发作时眼内压所用时间长,前房内炎症反应较重；ACP能安全迅速降低眼压,操作简单可重复,无严重并发症,可作为首选治疗措施.

Objective To evaluate the practicability and safety between paracentesis of anterior chamber and laser peripheral iridoplasty as an initial treatment for acute attack of primary angle-closure glaucoma. Methods Fifty-five eyes （52 cases） with acute primary angle-closure glaucoma were divided into 2 groups.Group A （27 eyes） was treated with paracentesis of anterior chamber.Another group （28 eyes） was treated with laser peripheral iridoplasty.The post-treatment clinical data including the time of intraocular pressure （IOP） decreased to 21mmHg （lmmHg=0.133KPa）,the angle of anterior chamber and the complications were observed.Results The IOP was reduced （12.7±3.4）mmHg,（13.6±5.8）mmHg,（14.2±4.4）mmHg,（19.6±5.2）mmHg,（18.3±4.5）mmHg,（19.7±3.1）mmHg,（17.5±5.6）mmHg at 30mins,lhr,2hrs,3hrs,4hrs,6hrs,12hrs after paracentesis of anterior chamber,respectively.The IOP of laser group were reduced （44.3±4.2）mmHg,（35.6±4.7）mmHg,（24.3±5.2）mmHg,（21.2±4.3）mmHg,（19.5±3.2）mmHg,（20.1±2.7）mmHg,（18.6±4.8）mmHg at the same time after treatment,respectively.There were statistical differences between the two groups in the IOP reduction at 30mins,lh and 2h （t =30.601,15.482,7.762; P 〈0.01）.There were no significant differences between the two groups in the scope of opening anterior chamber angle （x2=0.559,P 〉0.05）.The complications were inflammatory reaction in the anterior chamber and cilio-choroidal detachment.There were no complications such as intraocular infection and massive hemorrhage in the epichoroidal space. Conclusions The time of IOP decreasing is slower,and the inflammatory reaction in anterior chamber is gravely when using laser peripheral iridoplasty in treating acute attack of primary angle-closure glaucoma patients.The IOP decrease quickly and safely with the paracentesis of anterior chamber.And there are no grave complications.The paraccntesis of anterior chamber can be applied as an initial treatment for acute attack of primary angle-closure glaucoma.