不同模式激光虹膜周边切除术对角膜内皮细胞的影响

Effect of different modes of laser peripheral iridectomy on corneal endothelial cells

目的探讨不同模式激光虹膜周边切除术对角膜内皮细胞的影响。方法临床病例对照研究。收集2011年1月至2013年12月在福建医科大学第一附属医院眼科诊断为闭角型青光眼，前房角关闭范围不超过180。的深色无隐窝的虹膜患者98例（134只眼），按数字表法随机分为三组：Nd：YAG激光组，传统联合激光组，改良联合激光组。Nd：YAG激光组采用单独Nd：YAG激光行激光周边虹膜切开术；传统联合激光组先采用532nm激光光凝，然后用Nd：YAG激光击穿；改良联合激光组先用Nd：YAG激光击射，再用532nm激光崩紧或拉开，必要时最后再用Nd：YAG激光击穿。记录激光能量，术前和术后1周、1及3个月采用角膜内皮镜检测切口周围的角膜内皮，测量角膜内皮细胞的密度、六边形细胞比例和细胞面积。结果改良联合激光组使用的532nm倍频激光能量明显低于传统联合激光组，改良联合激光组使用的Nd：YAG激光明显低于Nd：YAG激光组和传统联合激光组，组间差异具有统计学意义（532nm倍频激光t=52．248，P〈0．01；Nd：YAG激光F=112．223，P〈O．01）。改良联合激光组术后切口周围角膜内皮细胞的密度较Nd：YAG激光组和传统联合激光组多（术前F=0．628，P=0．535；术后1周F=38．958，P〈0．01；术后1个月F=9．103，P〈0．01；术后3个月F=3．010，P=O．053），改良联合激光组术后切口周围角膜内皮六边形细胞比例较Nd：YAG激光组和传统联合激光组大（术前F=O．012，P=0．988；术后1周F=4．937，P〈0．01；术后1个月F=0．895，P=0．411；术后3个月F=1．370，P=0．258），改良联合激光组术后切口周围角膜内皮细胞面积较Nd：YAG激光组和传统联合激光组小（术前F=1．959，P：0．146；术后1周F=3．184，P=0．045；术后1个月F=35．184，P〈0．01；术后3个月F=27．160，P〈0．01）。结论改良联合激光虹膜周边切除术减少激光能量，减轻角膜内皮细胞的损伤，对深色无隐窝的虹膜的闭角型青光眼患者是一种安全有效的治疗方式。

Objective To investigate the effect of different modes of laser peripheral iridectomy on corneal endothelial cells. Methods A total of 98 cases （134 eyes） of angleclosure glaucoma pa tients, whose anterior chamber angle closure did not exceed 180 o and iris was dark brown without crypt were collected from January 2011 to December 2013 in our hospital. Patients were randomly divided into three groups： the Nd：YAG group, the traditional combined laser group and the modified combined laser group. Patients in the Nd：YAG group were performed Nd：YAG laser only. Patients in the traditional combined laser group were firstly performed 532nm Argon laser, followed by Nd： YAG laser. Patients in the modified combined laser group were firstly performed Nd：YAG laser, followed by 532nm Argon laser, when necessary using Nd：YAG laser for breakdown. Laser energy was recorded. The corneal endothelial cells were measured using corneal endothelial microscope preopera tive and I week, 1 month and 3 months postoperatively. The corneal endothelial cell density, hexago nal cell ratio and cell area were calculated. Results The 532nm Argon laser energy used in the modified combined laser group was significantly lower than that in the traditional combined laser group. The Nd：YAG laser energy used in the modified combined laser group was significantly lower than that in the Nd：YAG group and the traditional combined laser group. The differences were statis tical significances （532nm Argon laser t=52.248, P 〈0.01; Nd：YAG laser F =112.223, P 〈0.01）. The corneal endothelial cell density in the modified combined laser group was more than that in the Nd： YAG group and the traditional combined laser group （preoperation F =0.628, P =0.535; 1 week af ter operation F =38.958, P 〈0.01; 1 month after operation F =9.103, P 〈0.01; 3 months after opera tion F =3.010, P =0.053）. The hexagonal cell ratio in the modified combined laser group was higher than that in the Nd：YAG group and the traditional combined laser group （preoperation F =0.0120 P =0.988; 1 week after operation F =4.937, P 〈0.01; 1 month after operation F =0.895, P =0.411; 3 months after operation F =1.370, P =0.258）. The corneal endothelial cell area in the modified com bined laser group was smaller than that in the Nd：YAG group and the traditional combined laser group （preoperation F =1.959, P =0.146; 1 week after operation F =3.184, P =0.045; 1 month af ter operation F =35.184, P 〈0.01; 3 months after operation F =27.160, P 〈0.01）. The differences were statistical significances. Conclusions Modified combined laser peripheral iridotomy can reduce laser energy; relieve the corneal endothelial cell injury induced by the operation. It is a safe and ef fective treatment for angleclosure glaucoma patients whose iris is dark brown without crypt.