阿普可乐定防止Nd∶YAG激光虹膜切除术后眼压升高

目的了解阿普可乐定是否有效降低棕色虹膜人种激光虹膜切除术后眼压急性升高。方法４８只原发性闭角型青光眼，按年龄、性别进行匹配，分为治疗组和对照组。治疗组术前１小时和术后即刻滴用１％阿普可乐定，对照组滴用安慰剂。术后０．５、１．０、１．５、２．０、３．５小时观察眼压和其他情况。结果激光治疗后，治疗组和对照组眼压最大升高值分别为０．６２±０．６７ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）和１．１３±０．８７ｋＰａ，两组间差异有显著性（Ｐ＝０．０３）。治疗组的眼压明显下降发生于Ｎｄ∶ＹＡＧ激光虹膜切除术后０．５、１．０和１．５小时。除治疗组激光虹膜切除术后瞳孔直径明显大于对照组外，未见其他眼部和全身的副作用。结论１％阿普可乐定在棕色人种中可以有效地防止Ｎｄ∶ＹＡＧ激光虹膜切除术后眼压升高     

应用可乐定滴眼液防止激光引起的眼压升高

观察用０．２５％可乐定滴眼液对Ｎｄ：ＹＡＧ激光所致眼压升高的预防作用。将用可乐定的１５０只及未用可乐定的１１９只青光眼与后发白内障患者对比，加用可乐定组激光所致眼压升高眼数的比率（９．３％）明显低于未用可乐定组（６３．０％），其眼压升高值≥１．０６ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）眼的比率（２０％）也明显低于未用可乐定组（１８．５％），且应用可乐走后眼压即使比较剧烈升高的３只眼，其升高后的峰值也不超过３．０６ｋＰａ。因此可以认为用可乐定滴眼液预防激光所致眼压升高安全有效，值得推荐。     

超声乳化白内障摘除及人工晶体植入术后早期眼压改变

目的探讨超声乳化白内障摘除及人工晶体植入术后早期的眼压变化。方法对４９例（５３只眼）白内障患者进行手术前及术后定期眼压测量。结果发现无论术毕对切口缝合与否,术后１０～１２小时眼压均较术前明显升高;缝合切口组眼压的升高程度明显高于不缝合切口组（ｔ分别为４．４１和３．３２,Ｐ分别为０．０００１和０．００２０）。术后１６只眼眼压＞３．００ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）,其中缝合切口组１０只眼（１０／２０,５０．０％）,不缝合切口组６只眼（６／３３,１８．２％）,两组间的差异有显著性（χ２＝５．９８２０,Ｐ＝０．０１４）。术后２２～２４小时眼压已明显降低,４６～４８小时已降至术前水平。结论超声乳化白内障摘除及人工晶体植入术后早期眼压有不同程度升高,缝合切口者眼压升高更为显著,应于术后注意测量眼压,以便及时作相应处理,提高手术疗效。     

现代白内障囊外摘除术后早期眼压的观察

目的探讨白内障囊外摘除术后早期眼压的变化情况。方法将５８只眼随机分为三组，对术后早期不同时间的眼压进行观察和对照。结果术后１小时眼压均低者不能测出；３小时平均眼压高于术前水平；６～１２小时达高峰，３１只眼（５３．４５％）眼压＞２．８０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），４只眼（６．９０％）眼压≥４．００ｋＰａ，最高眼压为４．４０ｋＰａ；２４小时后眼压自然下降；术后７２小时内，５只眼（８．６２％）眼压低于正常水平（＜１．３３ｋＰａ）。术前应用醋氮酰胺组，术后平均眼压低于应用甘露醇组和未用降眼压药组（Ｐ＜０．０５），且术后正常眼压者所占比例较高。结论术前预防性服用醋氮酰胺，对降低白内障摘除术后早期的眼压有一定作用。     

砝码式压迫器的临床应用及机理探讨

本文报告用砝码式压迫器控制眶压眼压后施行白内障摘出手术１７０眼，玻璃体脱出率为４．７％（８／１７０）。对４０只眼在压迫前及压迫１５分钟后测量眼压，平均眼压分别为２．２５±０．６３ｋＰａ（１６．９±４．７）及１．０１±０．６５ｋＰａ（７．６５±４．８６ｍｍＨｇ）；平均下降１．２５ｋＰａ（９．３４ｍｍＨｇ），下降率为４４．７％。     

Nd：YAG激光经巩膜睫状体光凝治疗晚期青光眼的初步报告

报告用平头石英光纤对２０例常规手术和药物不能控制眼压的晚期青光眼患者实施Ｎｄ：ＹＡＧ激光接触式经巩膜睫状体光凝降眼压的初步结果。光凝前平均眼压为７．５７±２．４４ｋＰａ，光凝后一周为４．３３±１．５４ｋＰａ，眼压下降有非常显著的意义。（Ｐ＜０．０１）。光凝分别以３、２．５、２Ｊ的能量在角膜缘后１．５ｍｍ做３０～９０个光凝点。结果表明：２Ｊ的能量做７０～９０个光凝点降眼压效果良好，光凝后眼前节反应轻     

小梁切除联合白内障囊外摘出及人工晶状体植入治疗青光眼合并白内障

报告青光眼合并白内障的患眼术后眼压，视力和并发症。方法用小梁切除联合白内障囊外摘出及人工晶状体植入治疗２５眼，术后平均随访１．２年±０．４６年。结果平均眼压由术前（２６．４８±４．６５）ｍｍＨｇ降到术后（１７．３３±４．５０）ｍｍＨｇ，其中６４％患眼眼压被控制在２１ｍｍｈｇ或以下；使用抗青光药物由术前平均１．７２种±０．７４种降到术后０．６４种±０．７５ｔｋｈ （Ｐ〈０．０１），４８％的患眼不需要     

激光治疗时的高眼压及其预防

观察２０４例２５３眼Ｎｄ：ＹＡＧ激光时发生的高眼压，发现闭角青光眼间歇期作激光虹膜切开时眼压明显升降（≥１．０６２ｋＰａ）者较多（２１．２％），升高幅度较大，有的可升高到７．９８ｋＰａ；临床前期及慢性闭角青光眼发生率较低（分别为９．４％及５．３％），最高不超过３．９９ｋＰａ，后内障切开时眼压明显升高者有６４．３％，高峰可达６．６５ｋＰａ，治疗前１小时半用噻吗心安滴眼可明显减低此种并发症的发生率或其     

小梁切除与白内障摘出联合手术临床分析

对２８例２９眼青光眼并发白内障于一眼的患者行小梁切除联合白内障囊外摘出术。术后平均眼压２．１６ｋＰａ。明显低于术前眼压５．３６ｋＰａ。术后矫正视力≥０．５者１２眼；０．３－０．４者１０眼，０．１－０．２者５眼。０．１以下者２眼；术后视力差的     

超声乳化白内障摘出联合小梁切除术疗效观察

目的探讨超声乳化白内障摘出人工晶状体植入联合小梁切除术的疗效和安全性。方法对３６例（３６眼）青光眼合并白内障患者行超声乳化白内障摘出人工晶状体植入联合小梁切除术，术后观察眼压、视力、滤过泡等情况。结果术前用药后平均眼压为（２３．６２±１２．３３）ｍｍＨｇ，术后１周、３月平均眼压为（１６．３７±５．３８）ｍｍＨｇ、（１５．７２±４．９６）ｍｍＨｇ。术后矫正视力数指１眼，０．１～０．５者２６眼，０．６～１．２者９眼。结论超声乳化白内障摘出人工晶状体植入联合小梁切除术安全有效，适用于青光眼合并白内障患者。     

毛果芸香碱防止Nd∶YAG激光虹膜切除术后眼压升高

目的:了解毛果芸香碱是否能有效降低棕色虹膜人种激光虹膜切除术后眼压急性升高。方法:原发性闭角型青光眼48例58眼,按年龄、性别进行匹配,分为治疗组和对照组。治疗组术前30min和术后即刻滴用20g/L毛果芸香碱,对照组滴用安慰剂。术后0.5,1.0,1.5,2.0,3.5h观察眼压和其他情况。结果:激光治疗后,治疗组和对照组眼压最大升高值分别为0.62±0.67kPa(1kPa=7.5mmHg)和1.13±0.87kPa,两组间差异有显著性(P=0.03)。治疗组的眼压明显下降发生于Nd∶YAG激光虹膜切除术后0.5,1.0和1.5h。除治疗组激光虹膜切除术后瞳孔直径明显小于对照组外,未见其他眼部和全身的副作用。结论:20g/L毛果芸香碱在棕色人种中可以有效地防止Nd∶YAG激光虹膜切除术后眼压升高。     

Brinzolamide 1% versus apraclonidine 0.5% to prevent intraocular pressure elevation after neodymium:YAG laser posterior capsulotomy

PURPOSE: To compare the efficacy of brinzolamide 1% with that of apraclonidine 0.5% in preventing intraocular pressure (IOP) rise after neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Department of Ophthalmology, Akdeniz University, Antalya, Turkey. METHODS: One hundred fifteen patients who had Nd:YAG laser posterior capsulotomy for posterior capsule opacification were prospectively randomized to receive brinzolamide 1% (57 patients) or apraclonidine 0.5% (58 patients) approximately 1 hour before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before treatment and after treatment at 1, 2, and 3 hours and 7 days. RESULTS: The mean IOP changes from baseline were not statistically different between the study groups at 1, 2, and 3 hours and 7 days (P =.109, P = .764, P =.275, and P =.879, respectively). The incidence of IOP elevation of 5 mm Hg or higher was 12.2% (7 of 57 eyes) in the brinzolamide group and 10.3% (6 of 58 eyes) in the apraclonidine group (P = .743); IOP elevations of 10 mm Hg and greater occurred in 3.5% (2 of 57 eyes) and 1.7% (1 of 58 eyes) (P = .618), respectively. There were no IOP elevations greater than 20 mm Hg in either group. CONCLUSION: Brinzolamide 1% and apraclonidine 0.5% given prophylactically before Nd:YAG laser capsulotomy were effective in preventing IOP spikes after treatment.     

激光虹膜切开与周边虹膜切除术治疗瞳孔闭锁继发青光眼的临床观察

目的 观察Nd:YAG激光虹膜切开术(LI)与虹膜周边切除术(PI)治疗瞳孔闭锁继发青光眼的临床疗效.方法 选取因葡萄膜炎引起瞳孔闭锁继发青光眼患者62例67只服,随机分为LI组和PI组.观察手术前后眼压、前房深度、炎症及虹膜切口通畅情况并进行统计学处理.平均随访时间(21.5±4.6)个月.结果 (1)LI组33只眼均能一次性击穿虹膜,前房深度由术前(0.67±0.31)mm加深为(2.58±0.26)mm,前后比较差异具有统计学意义.术后24h眼压南术前(28.22±7.12)mmHg降至(20.06±3.59)mmHg,前后比较差异具有统计学意义.术后26只眼(78.8%)发生激光孔闭合,未行再次激光治疗,22只眼行PI,4只眼行滤过手术.(2)PI组34只眼均形成通畅的周切口,术后结膜充血、前房炎症反应明显减轻.前房深度由术前(0.71±0.48)mm加深为(2.61±0.33)mm,前后比较差异具有统计学意义.眼压由术前(27.54±6.69)mmHg降至最未次随访(15.79±3.67)mmHg,前后比较差异具有非常统计学意义,手术成功率79.4%.结论 PI不仅能有效解除瞳孔闭锁、控制眼乐,而且有利于控制炎症、缩短疗程.     

Akutes Winkelblockglaukom trotz vorhandener Nd:YAG-Laser-Iridotomie

BACKGROUND: Nd:YAG laser iridotomy is routinely used as a procedure for primary acute angle-closure glaucoma (AACG). The clear advantage of Nd:YAG laser iridotomy is to resolve pupillary block without opening the eye. Nevertheless it remains unclear whether Nd:YAG laser iridotomy is equally effective as surgical iridectomy. In this context cases in which AACG recurred despite patent Nd:YAG laser iridotomy are of interest. PATIENTS AND METHODS: In a retrospective study, we analyzed the charts of 90 patients who presented with unilateral primary AACG in our department over 3 years and were treated with a surgical iridectomy. Surgical iridectomy at the 12 o'clock position was performed using a self-sealing corneal incision. RESULTS: Of the 90 patients with primary AACG, 13 (14.4%) had already been treated with Nd:YAG laser iridotomy. Despite the laser iridotomy, these eyes developed recurrent AACG. The presenting intraocular pressure (IOP) of these 13 eyes was 49.07+/-12.65 mmHg. In 4 eyes, continuous medical glaucoma therapy was used prior to AACG, 8 eyes showed signs of glaucoma damage at the optic disk or/and the visual field. In 2 eyes, the presenting high IOP at AACG could be lowered by medication. All other eyes were operated at high IOP. The average interval between the Nd:YAG laser iridotomy and the AACG was 24.5 weeks. After surgical iridectomy, the IOP was reduced to 12.69+/-4.11 mmHg and was 16.62+/-3.86 mmHg at the end of the observation period. CONCLUSIONS: In spite of Nd:YAG laser iridotomy recurrent AACG can occur. Surgical iridectomy is capable of permanently resolving the pupillar block in these cases.     

Brimonidine 0.15% versus apraclonidine 0.5% for prevention of intraocular pressure elevation after anterior segment laser surgery

PURPOSE: To compare the efficacy and safety of brimonidine 0.15% with those of apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after anterior segment laser surgery. SETTING: Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts, USA. METHODS: This double-masked randomized trial 80 eyes of 80 patients who had laser peripheral iridotomy, argon laser trabeculoplasty, or neodymium:YAG laser capsulotomy. Eyes received 1 drop of brimonidine 0.15% or apraclonidine 0.5% before laser surgery. Intraocular pressure, heart rate, and blood pressure were measured before laser surgery and at 1 hour, 3 hours, 24 hours, and 1 week after laser surgery. RESULTS: Before laser treatment, 41 patients received brimonidine 0.15% and 39 received apraclonidine 0.5%. Thirteen (31.7%) patients in the brimonidine group and 11 (28.2%) in the apraclonidine group had postoperative IOP elevations of 5 mm Hg or more (P = .5). Four patients (9.8%) in the brimonidine group and 3 (7.7%) in the apraclonidine group had IOP increases of 10 mm Hg or more (P = .5). There were no statistically significant changes in mean heart rate or blood pressure in either group except a slight reduction in diastolic blood pressure at 1 hour in the brimonidine group (-4.7 +/- 9.2 mm Hg) compared with that in the apraclonidine group (-0.1 +/- 9.1 mm Hg) (P = .01). No clinically significant side effects were noted in either group. CONCLUSION: A single preoperative drop of brimonidine 0.15% had similar efficacy and safety as apraclonidine 0.5% in preventing IOP elevations immediately after anterior segment laser surgery.     

532nm激光联合Nd:YAG激光周边虹膜切除术治疗早期瞳孔闭锁性青光眼

目的:探讨532nm激光+Nd:YAG激光周边虹膜切除术治疗早期瞳孔闭锁性青光眼的安全性和有效性。方法:将符合标准的56例瞳孔闭锁性青光眼患者按完全随机对照顺序编号,分成A,B两组。A组28例接受ND:YAG激光治疗,B组28例接受532nm激光+ND:YAG激光治疗,通过对视力、眼压、激光孔洞、视野和房角等观察,重点观察眼压控制情况。结果:经过2a的临床随访观察,眼压:A组术前(28.32±3.43)mmHg,术后(24.82±3.27)mmHg,采用配对t检查(tA=3.256)差异无统计学意义,A组眼压控制不理想;B组术前(28.79±3.63)mmHg,术后(15.31±3.18)mmHg,采用配对t检查(tB=26.315,P<0.05)差异有统计学意义;A,B两组激光治疗后眼压控制情况比较,差异有统计学意义(χ2=42.23,P<0.05)。视力:A,B两组治疗前后经t检验,A组:tA=2.375,B组:tB=2.362,视力变化无统计学意义,A,B两组间比较差异也无统计学意义(χ2=3.845)。并发症:A,B两组均无较严重并发症发生。结论:532nm激光+ND:YAG激光周边虹膜切除术是治疗早期瞳孔闭锁性青光眼的安全、有效方法,能明显降低眼压,保存视功能。     

Dorzolamide X apraclonidine in the prevention of the intraocular pressure spike after Nd : YAG laser posterior capsulotomy

OBJECTIVE: To evaluate the efficacy of dorzolamide compared to apraclonidine, in the prevention of the intra-ocular pressure (IOP) spike after Nd :YAG laser posterior capsulotomy. SITE: Department of Ophthalmology, State University of Campinas (UNICAMP) General Hospital, Campinas, S?o Paulo, Brazil. METHODS: In a double masked prospective clinical trial, 217 eyes from 217 patients were randomly assigned to receive either dorzolamide 2 h before and placebo 1 h before Nd : YAG laser capsulotomy or placebo 2 h before and apraclonidine 1 h before the procedure. Inclusion criteria were secondary cataracts with reduction in best corrected visual acuity (BCVA < 20/40), absence of manifest or suspected glaucoma and no known hypersensitivity to the study drugs. IOP was measured 2 h and 1 h before applying the laser, and 1 h, 2 h, 3 h and 7 days after. RESULTS: There were no statistically significant differences between the two groups regarding the IOP 2 h and 1 h before the procedure, and 1 h, 2 h, 3 h and 7 days after the laser treatment (p values, respectively: 0.077, 0.21, 0.085, 0.36, and 0.60). CONCLUSION: The results of this study suggest that dorzolamide is as safe and effective as apraclonidine in the prevention of the IOP elevation after Nd : YAG laser posterior capsulotomy. Synopsis. The efficacy of dorzolamide was compared to apraclonidine in the prevention of the intraocular pressure spike after Nd : YAG laser posterior capsulotomy in 217 patients and the results were similar with both drugs.     

Effect of 0.2% brimonidine in preventing intraocular pressure elevation after Nd:YAG laser posterior capsulotomy

BACKGROUND AND OBJECTIVE: To determine the prophylactic effect of 0.2% brimonidine in reducing the elevated intraocular pressure (IOP) in patients undergoing Nd:YAG laser posterior capsulotomy. PATIENTS AND METHODS: The 81 patients (81 eyes), who underwent Nd:YAG laser posterior capsulotomy, were allocated to two treatment groups. One drop of 0.2% brimonidine or vehicle was instilled 1 hour preoperatively and one drop immediately after capsulotomy. IOPs were measured preoperatively and 1, 2, 3, and 24 hours postoperatively. RESULTS: Intraocular pressure decreased from the baseline in the brimonidine group by the third postoperative hour (P<0.05), while the vehicle group exhibited an increase. Intraocular pressure elevations of 5 mm Hg or greater occurred in 7.3% (3/41) in the brimonidine group compared to 20.0% (8/40) in the vehicle group. IOP elevations of 10 mm Hg or greater occurred in 2.4% (1/41) in the brimonidine group compared to 7.5% (3/40) in the vehicle group. CONCLUSIONS: One drop of 0.2% brimonidine instilled 1 hour preoperatively and immediately after capsulotomy was found to be efficacious and safe in preventing IOP elevations that frequently follow Nd:YAG laser posterior capsulotomy.     

Reversal of intraocular pressure increases with 0.5% apraclonidine after dilated fundus examination in patients with chronic open-angle glaucoma.

BACKGROUND: Apraclonidine 1.0% has been shown to reverse the potential intraocular pressure (IOP) increase after pupil dilation IOP increases in patients with chronic open-angle glaucoma. However, it is only approved for preventing IOP spikes after laser surgery. The purpose of this study is to determine the effectiveness of 0.5% apraclonidine in reversing IOP increases after pupillary dilation in patients with chronic open-angle glaucoma. METHODS: Twenty-two patients with chronic open-angle glaucoma were found to have an increase in post-dilation IOP of at least 4 mmHg from pre-dilated levels (baseline) in both eyes. IOP was measured 1 hour after dilation, after which two drops of 0.5% apraclonidine were instilled in one eye and the IOP was remeasured 15 minutes later in both eyes. Instillation of 0.5% apraclonidine in one eye was continued every 15 minutes and IOP was measured 15 minutes after each instillation, until the pressure returned to baseline levels. RESULTS: The IOP of the initially treated eye of all 22 patients returned to within levels clinically insignificant from baseline IOP within 90 minutes. By comparison, the IOP of the control group (untreated eye) remained elevated. Once the initial treatment eye returned to baseline levels, the control group was then treated with 0.5% apraclonidine, resulting in a lowering effect of the IOP in similar fashion to the initial treated group. CONCLUSIONS: Apraclonidine 0.5% appears to be effective in reduction of post-dilated IOP increases in patients with chronic open-angle glaucoma.     

Nd:YAG激光虹膜切除术治疗葡萄膜炎继发闭角型青光眼

目的 评价Nd：YAG激光虹膜切除术治疗葡萄膜炎继发闭角型青光眼的临床效果。方法 回顾性分析27例葡萄膜炎继发瞳孔阻滞闭角型青光眼经Nd：YAG激光虹膜切除术治疗的情况。随诊时间2月到4年。结果1)一次激光所有患眼均成功击穿虹膜。虽经术后积极抗炎治疗．12眼(44％)发生虹膜孔关闭。多次激光治疗后，最终89％的患眼获得了通畅的激光孔。2)在46次激光治疗中，击射点数为3～376点，激光能量为12～2077mJ。所用激光能量较原发闭角型青光眼高。3)75％的患眼激光治疗后眼压控制正常，6只眼(22％)眼压不能控制行滤过手术。4)激光手术的并发症主要是激光时虹膜的出血和暂时的眼压升高。5)术前有活动性炎症的患眼，发生激光孔闭合的比例更高。结论 Nd：YAG激光虹膜切除术是治疗葡萄膜炎继发闭角型青光眼的一种安全有效的方法。为提高手术的成功率，应在积极抗炎的同时，尽早行激光虹膜切除术。若激光后虹膜孔反复关闭，应考虑手术周边虹膜切除术。