探讨Nd：YAG激光周边虹膜切除术远期疗效的预测

The forecast of long-term efficacy of Nd： YAG laser peripheral iridectomy

目的探讨Nd：YAG激光周边虹膜切除术对闭角型青光眼的远期疗效的预测方法。方法对156例（204眼）接受Nd：YAG激光周边虹膜切除术1～5年后的原发性急性闭角型青光眼临床前期、缓解期和原发性慢性闭角型青光眼早期的患眼进行回顾性的多因素分析。其内容包括：手术前后视力、眼压，中央和周边前房深度、前房角形态以及杯盘比值，部分患者还作暗室试验和视野检查。结果204眼术后，30眼（14．7％）1～5年前房角出现新的粘连闭合或原粘连闭合继续扩大，并发生青光眼性的视功能损害。这些失败眼术前都具有前房隐窝浅、虹膜根部附止靠前、虹膜呈爬行性前粘连，或术后周边前房未明显加深，房角未加宽的临床特点。结论正确评估手术前前房角的形态结构和观测手术后周边前房深度的变化是预测激光周边虹膜切除手术远期疗效的方法，是筛选13后会失败的高危眼的两个重要指标。

Objective To study the prediction of the long-term efficacy of the Nd：YAG laser peripheral iridectomy for primary angle-closure glaucoma. Methods 204 eyes of 156 cases with primary acute angle-closure glaucoma including preelinical stage, remission stage or early primary chronic angle-closure glaucoma received Nd： YAG laser peripheral iridectomy treatment, and were followed up for 1 to 5 years. The observed data included the visual acuity before and after operation, intraocular pressure, the central and peripheral anterior chamber depth, angle forms and the cup disc ratio, and in some patients the darkroom test and visual field were retrospectively analysed. Results Of 204 eyes received Nd： YAG laser peripheral iridectomy, 30 eyes （ 14.7% ） developed new anterior chamber adhesion and closure or the original adhesion expanded, and complicated with glaucoma visual function damage at 1 -5 years after laser treatment. These failed cases had common morphologic features： shallow anterior chamber, forward ended iris root, peripheral iris syneehia before the iridectomy, or no obvious deepening of anterior chamber or broadening of anterior chamber angle after irideetomy. Conclusion The correct evaluation of preoperative morphological structure of anterior chamber angle and observation of changes of postoperative peripheral anterior chamber depth after iridectomy are two important forecast factors for postoperative long-term curative effect.