改良激光房角成形术治疗原发性闭角型青光眼

Clinical study on modified laser gonioplasty for primary angle-closure glaucoma

目的 探索提高激光房角成形术治疗原发性闭角型青光眼远期效果的新术式。方法 在门诊选择确诊的房角粘连超过 180°的原发性闭角型青光眼患者 80例 112眼 ,随机分成实验组与对照组 ,每组 4 0例。对照组 4 0例 5 7眼 ,采用激光房角成形术加激光周边虹膜切除术治疗。实验组 4 0例 5 5眼 ,在激光房角成形术的基础上再光凝巩膜突及根部虹膜打微孔 ,每个象限 1～ 2个。术后随访 2a以上 ,观察眼压、视力、视野、房角宽度和C值。结果 实验组成功率为 97.5 % ,对照组成功率为 87.7% ,χ2 检验其差异有显著性 (P <0 .0 5 ) ,2组患者激光术后眼压均有不同程度下降与术前比较均有显著性 (P <0 .0 0 1) ,房角与C值均有明显改善 (P <0 .0 1) ,但以实验组改善更为显著。 2组间术前眼压、房角宽度和C值比较无差异 (P均 >0 .0 5 ) ,但术后比较则有差异 (P均 <0 .0 5 ) ,视力、视野均比术前有所改善。结论 改良激光房角成形术是治疗原发性闭角型青光眼的安全有效方法。

Objective To probe into the way of improving the long time follow up result of laser gonioplasty for primary angle closure glaucoma.Methods Eighty cases(112 eyes) of primary angle closure glaucoma with goniosynechia over 180°were divided randomly into experimental group and control group in out patient.Forty cases(57 eyes) in control group were treated with laser gonioplasty, and forty cases(55 eyes) in experimental group were treated with modified laser gonioplasty.All cases were followed up over two years, and their visual acuity, visual field, intraocular pression,anterior chamber angle,and coefficient of outflow facility were observed.Results It was demonstrated that the successful rate in the experimental group was 97.5%,in the control group was 87.7%,the difference was significant(χ 2= 4.619 6 , P <0.05).The intraocular pression of the cases in two groups were decrease in the different degree after laser surgery,which showed significant difference comparing to it before the treatment ( t=13 833,P <0.001),the condition of anterior chamber angle and C value all were obviously improved( P <0 01),but more improved in the experimental group.Intraocular pressure,anterior chamber angle,and coefficient of outflow facility in two groups were no significant difference( P >0.05) before treatment,a significant difference( P <0.05) after treatment. Visual acuity,visual field were progressive to some extent.Conclusion Modified laser gonioplasty is the safe and effective way for primary angle closure glaucoma.