急性闭角型青光眼急性发作早期行前房穿刺联合Nd:YAG激光治疗的可行性

Effect of combined therapy of anterior chamber paracentesis and Nd:YAG laser peripheral iridectomy on acute angle-closure glaucoma in early different stages

目的分析急性闭角型青光眼急性发作早期行前房穿刺联合Nd：YAG激光治疗的可行性，为临床治疗提供参考。方法选取我院在2013年4月～2015年3月收治急性闭角型青光眼手气急性发作患者72例（72只眼）为研究对象，所有患者均采取前房穿刺术联合Nd：YAG激光治疗。依照发作时间差异分为早期组26例、中期组22例和晚期组24例，早期组患者就诊时间在24h内，中期组患者就诊时间在24～72h，晚期组患者就诊时间在72h以上，分析三组患者眼压、视力等情况。结果早期组患者眼压控制有效率（84．6％）明显高于其他两组，中期组患者眼压控制有效率（50．0％）明显高于晚期组（20．8％）。手术前，三组患者眼压差异不明显（P〉0．05），早期组患者术后2d眼压（14．06±4．8）mmHg明显低于中期组和晚期组，中期组患者术后2d眼压（24．53±6．1）mmHg明显低于晚期组（31．86±5．2）mmHg（P〈0．05），早期组患者前房角开放有效率（88．5％）明显优于其他两组，中期组患者眼角开放有效率（54．5％）明显优于完全组（20．8％）（P〈0．05），早期组患者出院视力（10．92±3．25）明显高于其他两组，中期组患者出院视力（8．61±2．37）明显高于晚期组（6．63±2．08）（P〈0．05），三组患者在治疗中均未出现严重前房出血、眼角膜损伤等严重并发症。结论急性闭角型青光眼早期联合使用激光和前房穿刺术能够有效开放房角，避免病情进展，减少滤过性手术，提高治疗效果。

Objective To evaluate the effect of the combined therapy of anterior chamber paracentesis and Nd：YAG laser peripheral iridectomy on acute angle closure glaucoma in early stages. Methods Altogether 72 （72 eyes） patients suffered acute angle-closure glaucoma from April 2013 to March 2015 for the first time were divided into three groups by the length of time from the attack to the diagnosis, the 26 patients （26 eyes） in early group were treated within 24 hours after the attack,22 patients（22 eyes） in middle term group within 24-72 hours and 24 patients（24 eyes） in advanced group within 72 hours. All the patients were given anterior chamber paracentesis and Nd：YAG laser periph- eral iridectomy once the intraocular pressure（IOP） couldn＇t be controlled with drugs 48 hours after the diagnosis. The IOP,anterior chamber angle and visual acuity were observed. Results IOP control effectiveness in the early group （84.6%） was significantly higher than the other two groups, IOP control efficiency in the mid-group （50.0%） was sig- nificantly higher than the late group （20.8%）. Intraocular pressure in patients with no significant difference between the three groups before surgery（P〉0.05）,after the 2 d IOP in the early group（14.06±4.8）mmHg was significantly lower than in the mid-early group and late group, after the 2 d IOP （24.53±6.1） mmHg in the medium term group was signifi- cantly lower than the late group（31.86±5.2）mmHg（P〈0.05）. Anterior chamber angle open cases （88.5%） in the early group was significantly better than the other two groups, his eyes open cases（54.5%） in the mid-complete group was significantly better than late group （20.8%） （P〈0.05）.Discharge of vision in the early group （10.92±3.25） was signifi- cantiy higher than the other two groups, the patient was discharged in mid-vision group（8.61±2.37） was significantly higher than the late group （6.63±2.08）（P〈0.05）. Three groups had no serious complications severe hyphema, corneal damage ＇in therapy. Conclusion At the early stage of acute attack of acute angle-closure glaucoma,the combination of anterior chamber paracentesis and Nd ：YAG laser peripheral iridectomy can control IOP effectively, prevent develop- ment of glaucoma and even avoid filtering operation.