激光周边虹膜成形术治疗高褶虹膜型青光眼的疗效观察

Clinical Observation on Curative Effects of Krypton Laser Peripheral Iridoplasty in Treating Plateau Iris Glaucoma

目的观察激光周边虹膜成形术治疗高褶虹膜型青光眼的安全性和有效性。方法高褶虹膜型青光眼患者30例52只眼,首先药物降压,然后行氪激光周边虹膜成形术,超声生物显微镜激光治疗前后测量的房角开放度数。结果术前、术后1周、术后2和6个月患者的眼压分别为(22.8±3.2)、(15.6±1.7)、(16.6±2.1)和(17.2±2.3)mmhg。术前与术后各时间段眼压比较差异均具有显著意义(P<0.05)。各部位房角开放度:术前鼻侧(11.76±4.51)°,下方(7.74±6.75)°,颞侧(9.81±6.94)°,上方(5.93±4.66)°;术后2周鼻侧(19.67±7.59)°,下方(13.80±7.61)°,颞侧(16.67±7.26)°,上方(12.30±8.24)°;术后6个月鼻侧(16.94±6.95)°,下方(11.38±5.71)°,颞侧(11.38±5.71)°,上方(10.23±6.23)°。激光术后2周及6个月各部位房角开放度数与术前比较差异均有显著意义(P<0.05)。术前、术后1周中央前房深度分别为(2.10±0.37)、(2.26±0.42)mm,术前与术后比较差异没有显著意义(P>0.05);术前、术后1周周边前房深度分别为(0.91±0.22)、(1.11±0.18)mm,术前与术后比较差异均有显著意义(P<0.05)。所有病例术后患眼眼压被控制,没有出现反应性的眼压升高、前房炎症反应,出血、虹膜局部色素脱失、沉着及虹膜萎缩等激光的副损伤。结论氪激光周边虹膜成形术对于房角尚未发生粘连的单纯虹膜肥厚的高褶虹膜型青光眼一种安全有效的方法,能有效加深患者房角及周边前房深度。

Objective To observe the safety and effectiveness of the laser peripheral iridoplasty in treating plateau iris glaucoma. Methods Fifty-two eyes of 30 patients with plateau iris glaucoma were enrolled and given krypton laser peripheral iridoplasty after being administered with antihypertensive drugs.The preoperative and postoperative angle-opening degrees were measured with ultrasound biomicroscopy. Results The preoperative and 1 week,2 month and 6 moth postoperative intraocular pressures（IOP） were（22.8±3.2）,（15.6±1.7）,（16.6±2.1） and（17.2±2.3） mmHg respectively.The difference between the preoperative and postoperative pressures was statistically significant（P0.05）.As to the angle opening,the mean open angles stood at（11.76±4.51）°（nasal）,（7.74±6.75）°（below）,（9.81±6.94）°（temporal） and（5.93±4.66）°（top） before the operation,（19.67±7.59）°（nasal）,（13.80±7.61）°（below）,（16.67±7.26）°（temporal） and（12.30±8.24）°（top） two weeks after the operation and（16.94±6.95）°（nasal）,（11.38±5.71）°（below）,（11.38±5.71）°（temporal） and（10.23±6.23）°（top） six months after the operation.Compared with the preoperative open angle,both the differences of the 2 week and 6 month postoperative open angles measured with ultrasound biomicroscopy were statistically significant（P0.05）.The difference of the open angles before and after the laser surgery was statistically significant（P0.05）.The central anterior chamber depths were（2.10±0.37） mm and（2.26±0.42） mm respectively before and one week after the operation,revealing that the difference is not statistically significant（P0.05）.The peripheral anterior chamber depths were（0.91±0.22） mm and（1.11±0.18） mm before and one week after the operation,indicating a difference of statistical significance（P0.05）. Conclusions Peripheral iridoplasty with krypton laser is a safe and effective treatment for plateau iris glaucoma,and can effectively increase open angle and peripheral anterior chamber depth.