联合激光周边虹膜切除术治疗原发性闭角型青光眼

Combined laser peripheral iridectomy for primary angle－closure glaucoma

目的:探讨联合激光周边虹膜切除术治疗原发性闭角型青光眼的临床疗效。方法:收集2015-08/2017-10在我院就诊的原发性闭角型青光眼患者82例82眼,随机分为单纯激光组(33例,采用Nd:YAG激光周边虹膜切除术)和联合激光组(49例,采用532半导体激光联合Nd:YAG激光周边虹膜切除术)。记录两组患者眼压、激光能量、虹膜出血情况。结果:单纯激光组患者术后眼压升高较联合激光组明显,术后1h,1d,1wk两组患者眼压差异明显(均P<0.01);术后1mo两组患者眼压基本恢复至术前水平。单纯激光组患者术中1次透切成功率明显低于联合激光组(73%vs 100%,P<0.05),且术中使用Nd:YAG激光总能量明显高于联合激光组(40.16±13.43mJ vs 23.23±6.70mJ,P<0.05)。两组患者术中虹膜出血率无明显差异(33%vs 26%,P>0.05)。结论:532半导体激光联合Nd:YAG激光行周边虹膜切除术1次透切率高,尤其对于无虹膜隐窝的患者,可明显降低激光操作难度,减少激光能量,减轻前房炎症反应。

AIM: To investigate the clinical effect of combined laser peripheral iridectomy for primary angle-closure glaucoma. METHODS: A total of 82 eyes were included in 82 patients with primary angle-closure glaucoma who visited our hospital from August 2015 to October 2017. They were randomly divided into two groups. Patients in the simple laser group were performed Nd:YAG laser only. In the combined laser group, 532 semiconductor laser combined with Nd: YAG laser were used for laser peripheral iridectomy. Intraocular pressure (IOP) was measured preoperative and postoperative. Laser energy was recorded. Iridemia were observed. RESULTS: Postoperative IOP increased significantly in the simple laser group compared with the combined laser group, and the differences between the two groups 1h, 1d and 1wk after operation were statistical significances ( P <0.01). The IOP of the two groups was basically restored to the preoperative level at 1mo postoperatively. The success rate of single laser surgery was significantly lower than that of combined laser surgery (73% vs 100%, P <0.05). The total energy of Nd:YAG laser was significantly higher than that of the combined laser group (40.16±13.43mJ vs 23.23±6.70mJ, P <0.05). There was no significant difference in intraoperative iris bleeding rate between the two groups (33% vs 26%, P >0.05). CONCLUSION: Totally 532 semiconductor laser combined with Nd: YAG laser for peripheral iridectomy has a high rate of penetration, especially for patients without iris recess. It can significantly decreases laser energy, reduces the difficulty of laser operation and relieves intraocular inflammation.