激光周边虹膜成形及切除术治疗药物难控制的急性闭角型青光眼

Laser peripheral iridoplasty combined with iridectomy for the unmanageable acute angle-closure glaucoma by medication

目的：探讨激光周边虹膜成形联合周边虹膜切除术，治疗药物难控制的急性闭角型青光眼的效果和安全性。方法：选取药物治疗24h后眼压仍高于21mmHg的原发性急性闭角型青光眼15例17眼和白内障膨胀期继发的急性闭角型青光眼4例4眼，共19例21眼，采用激光周边虹膜成形联合周边虹膜切除术，术后24h观察视力、眼压、角膜、周边前房深度、房角及并发症。结果：所有患者激光术后24h眼压均有大幅度的下降，术前眼压53.09±11.01mmHg，术后24h眼压下降至14.98±4.21mmHg，治疗前后差异有统计学意义（P〈0.01 ）。术后视力由术前手动～0.3提高至0.1～1.0。所有患者角膜水肿减轻或消退，周边前房深度增加，房角不同程度开放。其中虹膜出血11眼（52.4%），轻度反应性虹膜炎21眼（100%），无1眼发生角膜灼伤。结论：激光周边虹膜切除联合周边虹膜成形术，是降低药物难控制的急性闭角型青光眼眼压的一种安全有效的方法。

AIM： To investigate the effect and safety of laser peripheral iridoplasty combined with iridectomy in the unmanageable acute angle-closure glaucoma by medication. METHODS： Totally 19 cases（21 eyes）with acute angle-closure glaucoma, including 15 cases（17 eyes）with primary glaucoma and 4 cases（4 eyes）with intumescent cataract-induced glaucoma, were recruited into the study. The intraocular pressure（IOP）of all cases were still 〉21mmHg after 24h drug treatment, and then were treated by laser peripheral iridoplasty combined with iridectomy. The visual accurity, IOP, cornea, peripheral anterior chamber depth, anterior chamber angle and complications were observed at 24h after the surgery. RESULTS： The mean IOP of all cases was reduced from 53.09±11.01mmHg before the surgery to 14.98±4.21mmHg at 24h after the treatment, with significant statistical difference（P〈0.01）. The visual acurity of all cases increased in different degrees from handle move to 0.3 to 0.1-1.0 at 24h after the treatment. In all cases, cornea edema reduced or cleared up, peripheral anterior chamber depth increased, and anterior chamber angle reopened in different degrees. Complications included iris hemorrhage in 11 eyes（52.4%）, mild iritis in 21 eyes（100%）. No cornea burn was encountered. CONCLUSION： Laser peripheral iridoplasty combined with iridectomy is an effective and safe method for the treatment of the unmanageable acute angle-closure glaucoma by medication.