Nd∶YAG激光虹膜穿孔术治疗闭角型青光眼临床分析

Treatment of Angle-closure Glaucoma by Using Nd∶YAG Laser to Perform Perforative Operation of the Iris: A Clinical Analysis

目的 探讨Nd∶YAG激光虹膜穿孔的术前准备、操作技巧、能量设置、适应证的标准化、治疗效果及并发症的防治。方法 采用国产JYZ 1型Nd∶YAG激光机对 15 6 2例 2 0 0 0眼的闭角型青光眼实施了虹膜穿孔术。结果 2 0 0 0眼全部穿孔成功 ,1次手术成功率为 75 % (15 0 0 / 2 0 0 0 ) ,2次手术成功率 2 0 4 % (40 8/ 2 0 0 0 ) ,3次及以上手术成功率4 6 % (92 / 2 0 0 0 )。患者眼压、视功能 98 9% (1978/ 2 0 0 0 )达到治愈标准 ,1 1% (2 2 / 2 0 0 0 )需要药物维持或改作滤过性手术 ,81 7% (16 34/ 2 0 0 0 )出现了一过性并发症 ,1 6 % (32 2 0 0 0 )出现了远期或有临床意义的并发症 ,而传统的周边虹膜切除术的远期并发症高达 4 5 7% (39/ 85 1)。结论 Nd∶YAG激光虹膜穿孔术治疗闭角型青光眼简便、安全、经济。

Objective To investigate Nd∶YAG laser perforative operation of the iris, preoperative preparedness, operating technique, energy setup, standardization of indication, treatment effect, control of complications, et al. Methods Two thousand eyes from 1562 cases with angle closure glaucoma were performed perforative operation of the iris by use of home made JYZ 1 type YAG machine. Results All of 2000 eyes were perforated successfully, the rate of success from 1 shot was 75%(1 500/2 000), from 2 shots was 20 4%(408/2 000), and from more than 3 shots was 4 6%(92/2 000). From them, 98 9%(1 978/2 000) were with practically normalized eye pressure and visual function, only 1 1%(22/2 000) needed drug support or other filterable operation; 81 7%(1 634/2 000) produced transient complications, only 1 6%(32/2 000) had delayed complications [vs 4 57%(39/851) with traditional cricoid resection of the iris]. Conclusions It is simple, safe economic and practical procedure to treat angle closure glaucoma.