激光周边虹膜成形术治疗虹膜切除术后暗室俯卧试验阳性的原发性闭角型青光眼

A clinical study on laser peripheral iridoplasty for primary angle-closure glaucoma with positive provocative tests after iridectomy

目的 评价激光周边虹膜成形术治疗虹膜切除术后暗室俯卧试验阳性的原发性闭角型青光眼的临床效果。方法 对激光周边虹膜切除术后暗室俯卧试验阳性的 34例 (5 6只眼 )原发性闭角型青光眼 (非眼外引流手术指征 ,前房角粘连 <1/2周前房角范围 )患者行激光周边虹膜成形术。其中急性闭角型青光眼 2 7例 (49只眼 ) ,慢性闭角型青光眼 7例 (7只眼 )。对患者治疗前后的周边前房深度、前房角、眼压、视野及周边虹膜形态进行详细的对比观察 ,并行暗室俯卧试验及散瞳试验检查。患者术后随访 1～ 4年。结果 所有患者治疗后周边前房深度均明显加深 ,静态前房角镜检查小梁网可见范围增宽。随访期间患者未发生高眼压、前房角进行性粘连及视野损害 ,暗室俯卧试验及散瞳试验均阴性。结论 虹膜切除术后暗室俯卧试验阳性的原发性闭角型青光眼的发病机制是当瞳孔散大时 ,异常的周边虹膜组织堵塞小梁网而引起高眼压 ,瞳孔阻滞因素不起主导作用。激光周边虹膜成形术可以明显改变此类青光眼患者 (前房角粘连 <1/2周前房角范围 )的周边虹膜形态 ,从而控制病情进展。

Objective To evaluate the therapeutic effects of laser peripheral iridoplasty for primary angle closure glaucoma with positive dark room and prone test after laser peripheral iridectomy. Methods A long term prospective study of 56 eyes (34 cases) with primary angle closure glaucoma was carried out. The patients presented with positive dark room and prone provocative test after laser peripheral iridectomy, and laser peripheral iridoplasty by Double Frequency Nd:YAG laser was performed on them. Their extent of goniosynechia was less than 1/2 circumference of the anterior chamber angle. Forty nine eyes (27 cases) of all those studied were acute angle closure glaucoma and the other 7 eyes (7 cases) were chronic angle closure glaucoma. The inferior peripheral anterior chamber depth, anterior chamber angle, the configuration of peripheral iris and intraocular pressure were observed carefully, and the dark room, prone and mydriatic provocative tests were performed. The postoperative follow up ranged from 1 year to 4 years. Results The results showed that in all these cases, the peripheral anterior chamber depth was increased, the anterior chamber angle was widened on goniscope and the trabecular meshwork could be visualized widely in static state. All patients did not have ocular hypertension and damage of visual field in the follow up. Mydriatic, dark room and prone provocative tests following laser peripheral iridoplasty were negative. Conclusions In some acute angle closure glaucoma and chronic angle closure glaucoma patients, the pupillary block is relieved by laser peripheral iridectomy, but provocative tests can also be positive because of the abnormal configuration of the peripheral iris. Pupillary dilation results in peripheral iris bunching, and the surface of the trabecular meshwork can be blocked, hypertension then occurs. But the laser peripheral iridoplasty can improve the shape of the peripheral iris effectively and it can prevent the disease from deteriorating. The goniscopic examination and provocative tests following laser peripheral iridectomy are very important and also effective in detecting this kind of glaucoma.