Nd：YAG激光房角穿孔术治疗改良黏小管切开术后高眼压效果的评价

目的对改良黏小管切开术（vcs）后高眼压的患者予Nd：YAG激光房角穿孔术（LGP）治疗，探讨其临床有效性及安全性。设计回顾性病例系列。研究对象改良VCS术后眼压升高，于表麻下行Nd：YAG激光房角穿孔术的26例患者（35眼）。方法对改良VCS术后随诊期间眼压高者在表麻下行Nd：YAG激光房角穿孔术。记录手术前后眼压、裂隙灯、房角镜、眼前节相干光断层成像（AS—OCT）检查结果，施行激光房角穿孔术的时间及手术成功率。主要指标眼压，房角镜、AS—OCT图像，激光时间。结果改良VCS术后平均眼压（23．3±8．2）mmHg，LGP术后平均眼压降至（17．6±6.3）mmHg。其中31眼（88．6％）眼压下降，4眼（11．4％）眼压升高。成功（眼压〈19mmHg，且较术前下降30％）15眼（42．9％）。长期随访（3个月～2年），15眼（42．9％）无须降眼压药物，20眼（57．1％）需联合降眼压药物才能降至靶眼压。2眼（5．7％）术后激光区域少量出血，l周后完全吸收。改良VCS术后3个月内行LGP者15眼（42．9％），3个月后行LGP者20眼（57．1％）。结论Nd：YAG激光房角穿孔术能有效降低改良VCS术后的眼压升高，安全性高，是其有效的补充。

The effect of Nd: YAG laser goniopuncture to manage high intraocular pressure after modified viscocanalostomy

Objective To discuss the clinical effect and safety of Nd：YAG laser goniopuncture, which was applied in patients with high intraocular pressure （IOP） after modified viscocanalostomy （VCS）. Design Retrospective case series. Participants 35 eyes of 26 patients who underwent laser goniopuncture after modified VCS. Methods Laser goniopuncture were performed on the patients with high IOP after modified VCS. The following examinations were carried out and recorded before and after laser treating： lOP, slit-lamp, gonioscopy, anterior segment optic coherence topography （AS-OCT） scan, laser time and success rate. Main Outcome Measures IOP, gonioscopy findings, AS-OCT scan images and the laser time. Results The mean IOP before laser goniopuncture was 23.3±8.2 mm Hg, which reduced to 17.6±6.3 mm Hg after laser gniopuncture. After laser goniopuncure, the IOP decreased in 31 eyes （88.6%） , and in- creased in 4 eyes （11.4%）. Success was defined as an IOP reduced to lower than 19 mm Hg and decreased at least 30% compared to the last preoperative measurement. The success rate was 42.9% （15 eyes ） in a short term. During three months＇ to two years＇ followup, target IOP control without medicine was achieved in 15 eyes （42.9%） . The lOP in the rest cases was controlled under target level with medicine. And 2 eyes （5.7%） had a little hemorrhage in the laser domain, which were absorbed completely after one week. Laser goniopuncture was carried out within 3 months after VCS in 15 eyes （42.9%）. Conclusion Nd：YAG laser goniopuncture is effective and safe to decrease the high IOP after modified VCS.