YAG激光虹膜根部造孔术与恶性青光眼的预防

目的:探讨YAG激光与恶性青光眼的预防。方法:通过对恶性青光眼早期保守治疗无效的患者行YAG激光虹膜根部造孔术,从而使前后房沟通,促进前房形成。结果:对恶性青光眼早期保守治疗无效的患者行YAG激光虹膜根部造孔术,能阻止其发展。结论:YAG激光虹膜根部造孔能有效预防恶性青光眼的发生。     

Recurrent closure of neodymium: YAG laser iridotomies requiring multiple treatments in pseudophakic pupillary block

We present a rare case of repeated closure of Nd:YAG laser iridotomies and recurrent iris bombe configuration with angle-closure attacks in a pseudophakic eye. Until recently, patent Nd:YAG laser iridotomies were considered incapable of being closed, and the only reported closure was in an eye with concomitant iritis. Our patient developed iris bombe five times following extracapsular extraction, anterior vitrectomy, and anterior-chamber intraocular lens implantation. The first occurred following closure of the surgical iridectomy; the next three times, following closure of previously patent Nd:YAG iridotomies; and the final episode occurred despite patent iridotomies. This last time one drop of pilocarpine 2% was administered and resulted in immediate iris flattening and reopening of the third iridotomy. Possible mechanisms for closure of the Nd:YAG iridotomies in this case are discussed. We suggest the combination of Nd:YAG laser iridotomies and the stretching of the iris by pilocarpine might have liberated the trapped aqueous humor behind the iris, maintaining the patency of the iridotomies and the depth of the anterior chamber.     

Laser treatment to large iris cyst secondary to trabeculectomy

CASE REPORT: We report a case of postoperative large iris cyst secondary to trabeculectomy treated with Nd:YAG laser iridocystotomy. The patient was subsequently free of discomfort or significant inflammation. COMMENTS: This case suggests that large iris cysts may produce corneal decompensation. Laser treatment can collapse the iris cyst without other ocular tissue damage.     

One-piece contact lens for laser iridotomy at iris base by argon and Nd:YAG laser

Laser iridotomies at the base of the iris provide a free shunt between the anterior and the posterior chamber remote from the capsule of the lens. Injury to the lens capsule by the Nd:YAG laser is avoided as the iris is not in close apposition. The heterocentric applanatic lens guides the laser beam under the limbal shelf toward the root of the iris. The combined use of a thermal and an ionizing laser is preferred.     

Nd: YAG laser treatment of anterior chamber implantation cysts

The development of an epithelial implantation cyst is a severe complication of anterior segment surgery and trauma. Two patients with anterior chamber implantation cysts were treated with Nd: YAG laser. One required surgical correction as the cyst reformed after each of 6 laser treatment sessions. In the other patient, the cyst reformed once, and has not recurred for 18 months since the second laser treatment. Collapse of anterior chamber implantation cysts can be achieved with Nd: YAG laser, though multiple treatment sessions may be required due to the cyst's tendency to reform.     

Treatment of late-onset capsular distension syndrome with a neodymium:YAG laser peripheral iridotomy and anterior capsulotomy

We describe a new approach to treat late-onset capsular distension syndrome in which the fluid in the capsular bag is cloudy and prevents a posterior neodymium:YAG (Nd:YAG) laser capsulotomy. A peripheral laser iridotomy is created through which the anterior lens capsule peripheral to the IOL optic is accessed. This opening in the iris provides an access point through which an anterior Nd:YAG laser capsulotomy can be performed. Following disruption of the anterior lens capsule, the capsular fluid is released into the anterior chamber and absorbed through the inherent drainage system of the eye. This approach avoids the need for a more invasive surgical intervention.     

Neodymium:YAG laser therapy for pseudophakic pupillary block

Pupillary block occurred in six patients with anterior chamber intraocular lens implants. After medical therapy failed, the Nd:YAG laser was used to break the hyaloid face in the pupillary and iridectomy apertures. Iridotomies were also produced at the sites of bulging iris. Following laser treatment the anterior chambers deepened and there were no further signs or symptoms of pupillary block. The Nd:YAG laser proved to be a useful treatment for pseudophakic pupillary block.     

Presumed epithelial inclusion cyst of the iris seven years after radial keratotomy

PURPOSE: To report a case of presumed epithelial inclusion cyst of the iris 7 years after radial keratotomy (RK) that was treated with double-frequency Nd:YAG laser (532 nm). METHODS: A young adult woman underwent bilateral RK for the correction of myopia of -4.50 Diopters 7 years prior to the development of a white mass in the anterior chamber of her left eye. There was no evidence of any other surgery or trauma to the eye during this period. An epithelial inclusion cyst of the iris was diagnosed, and double-frequency Nd:YAG laser (532 nm) was used to coagulate the cyst under topical anesthesia. RESULTS: The size of the cyst reduced significantly immediately following laser treatment, and the prelaser visual acuity of 6/12 was maintained at 6 months' follow-up without any recurrence. CONCLUSIONS: In the absence of evidence of any other surgery or trauma, the most likely cause of the epithelial inclusion cyst of the iris following RK is epithelial seeding from the original surgery, which is amenable to coagulation with double-frequency Nd:YAG laser.     

激光周边虹膜成形术联合周边虹膜切除术治疗高褶虹膜型青光眼

目的探讨采用联合激光技术治疗高褶虹膜型青光眼的疗效。方法对２０例（３７只眼）早期原发性慢性闭角型高褶虹膜型青光眼，一次性行氩激光周边虹膜成形术联合氩激光加ＮｄＹＡＧ激光周边虹膜切除术（联合激光手术）。结果随访８个月至４年零７个月，平均２．７年。１７例（３２只眼）获得满意疗效，在观察期内无青光眼急性发作，眼压从５．８０±１．０４ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）下降到２．７４ｋＰａ以下，周边前房加深，房角增宽，虹膜皱缩，有效地防止了房角的进一步粘连，８６．７％的患者暗室试验转阴性。结论联合激光手术是治疗高褶虹膜型青光眼的有效方法之一。     

探讨Nd：YAG激光周边虹膜切除术远期疗效的预测

目的探讨Nd：YAG激光周边虹膜切除术对闭角型青光眼的远期疗效的预测方法。方法对156例（204眼）接受Nd：YAG激光周边虹膜切除术1～5年后的原发性急性闭角型青光眼临床前期、缓解期和原发性慢性闭角型青光眼早期的患眼进行回顾性的多因素分析。其内容包括：手术前后视力、眼压,中央和周边前房深度、前房角形态以及杯盘比值,部分患者还作暗室试验和视野检查。结果204眼术后,30眼（14．7％）1～5年前房角出现新的粘连闭合或原粘连闭合继续扩大,并发生青光眼性的视功能损害。这些失败眼术前都具有前房隐窝浅、虹膜根部附止靠前、虹膜呈爬行性前粘连,或术后周边前房未明显加深,房角未加宽的临床特点。结论正确评估手术前前房角的形态结构和观测手术后周边前房深度的变化是预测激光周边虹膜切除手术远期疗效的方法,是筛选13后会失败的高危眼的两个重要指标。     

Laser iridocystotomy for bilateral acute angle-closure glaucoma secondary to iris cysts

PURPOSE: To report laser iridocystotomy for bilateral acute angle-closure glaucoma secondary to peripheral iris cysts. METHOD: Case report. RESULTS: In a 55-year-old man with increased bilateral intraocular pressure, gonioscopy revealed varied angle narrowing. Bilateral angle-closure glaucoma secondary to peripheral iris cysts was diagnosed by ultrasound biomicroscopy. The peripheral iris cysts could not be seen in mydriasis by gonioscopy. Therefore, we decided to perform laser iridocystotomy with argon and Nd:YAG laser. Collapse of the cysts after laser treatment was demonstrated by ultrasound biomicroscopy. At follow-up, 9 months after laser treatment, intraocular pressure had dropped below 20 mm Hg in both eyes without further therapy. The iris cysts did not recur, which was demonstrated by ultrasound biomicroscopy. CONCLUSIONS: Peripheral iris cysts may produce angle closure and may cause secondary angle-closure glaucoma. If transpupillary laser cystotomy is not possible, laser iridocystotomy may produce collapse of the iris cysts and correction of secondary angle closure.     

葡萄膜炎-青光眼-前房积血综合征的临床特征分析

目的 回顾分析葡萄膜炎-青光眼-前房积血(UGH)综合征的临床特征。设计回顾性病例系列。研究对象2018-2022年山东中医药大学附属眼科医院UGH患者8例(8眼)。方法回顾患者的病历资料,总结其临床表现、治疗方法及预后。主要指标临床表现及影像学检查结果。结果所有8例患者均为IOL植入术后1～6个月出现本病临床表现。平均眼压(42.91±11.54)mmHg,均存在不同程度的前房闪辉,前房积血4例,房水涂片存在红细胞4例。IOL偏位并与虹膜及睫状体接触,2例因虹膜后凹致IOL与虹膜后表面接触,4例IOL偏位与虹膜后表面接触,1例与睫状体接触。1例采用药物治疗,2例虹膜后凹的患者采用YAG激光虹膜切开,IOL调位术、IOL置换术、IOL取出术、青光眼阀植入术、睫状体光凝术各1例。治疗后随访6～46个月,前房闪辉及房水红细胞消失,IOL与虹膜及睫状体接触消失。结论UGH综合征的临床特征表现为白内障术后IOL与虹膜睫状体接触、眼压升高、前房闪辉、房水存在红细胞。其治疗以解除IOL与周围组织的摩擦为根本措施。(眼科,2023,32:127-132)     

闭角型青光眼中虹膜睫状体囊肿的发病情况

目的:观察闭角型青光眼中虹膜睫状体囊肿的发病情况,虹膜睫状体囊肿与前房轴深、房角的关系。方法:利用超声生物显微镜(UBM)对闭角型青光眼患者740例1057眼进行眼前节检查。结果:闭角型青光眼740例1057眼中检出合并虹膜睫状体囊肿者42例60眼,占被检眼数的5.68%。60眼虹膜睫状体囊肿中虹膜睫状沟囊肿56眼(93.33%),睫状冠囊肿4眼(6.67%);其中单发囊肿33眼(55.00%),多发囊肿27眼(45.00%)。不伴有虹膜睫状体囊肿的患者前房轴深1.16～2.37(平均1.843)mm;合并有虹膜睫状体囊肿的患者前房轴深1.67～2.78(平均2.297)mm。伴有及不伴有虹膜睫状体囊肿的闭角型青光眼患者房角粘连>2个象限的比率分别为66.67%和44.59%。结论:虹膜睫状体囊肿在闭角型青光眼中的发病率较高,多为虹膜睫状沟囊肿,对前房轴深影响不大,但可以增加房角粘连范围,引起闭角型青光眼。     

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.     

氪离子与Q-开关Nd∶YAG激光联合激光虹膜切除术的远期疗效

目的:观察氪离子激光与Q-开关Nd∶YAG激光联合应用治疗原发性闭角型青光眼的远期疗效,并与近期疗效比较。方法:对我院39例(48眼)原发性闭角型青光眼患者,采用氪离子激光与Q-开关Nd∶YAG激光联合应用的方法,行激光周边虹膜切除术。评价术后1a与7a的疗效,并进行统计学比较。结果:虹膜透切率达100.0%,一次透切成功率达97.9%。术后1a随访时发现眼压在正常水平内,且均值比术前低;术后7a随访眼压与1a无统计学差异。视力情况在术后1a不变或轻度改善,但在第2次随访时发现有5例(7眼)视力轻度下降。房角情况在术后1a也较术前略为改善,且这种改善维持到第2次随访时。至于周边前房深度,术后1a随访时明显强于术前,第2次随访时发现新出现5例患者周边前房深度变浅;视野情况术后1a与术后7a无明显变化,均发现早期青光眼视野缺损消失。结论:联合激光虹膜切除术是预防和治疗原发性闭角型青光眼临床前期的有效术式,近、远期疗效确切,是一种较为理想的术式,可在相当时期内有效预防青光眼急性发作。     

Primary iris stromal cyst with unusual symptoms in an adult

BACKGROUND: Most epithelial cysts of the anterior chamber ("iris stromal cysts") occur after penetrating ocular injuries and represent secondary epithelial ingrowth. Primary iris stromal cysts are less common and mostly congenital. Acquired primary iris stromal cysts in adults are extremely rare and cause less often symptoms than congenital cysts. PATIENT: A 41-year old patient presented with sudden loss of visual acuity, epiphora and photophobia of his right eye. A large iris cyst was found in the nasal lower quadrant of the anterior chamber. It had not been present 3 years before when the patient was last seen by an ophthalmologist. There was no history of trauma and no signs of preceding ocular injury at slit-lamp examination. The cyst was surgically removed by iridocyclectomy. Postoperatively the patient developed cataract and macular edema. A phacoemulsification with posterior chamber lens implantation as well as a systemic treatment with steroids and acetazolamide were necessary. Until now, two years after surgery, the cyst did not recur. CONCLUSIONS: Primary iris stromal cysts also occur in adults. In contrast to previous reports the cyst of our patient has caused acute symptoms.     

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

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。     

A malignant glaucoma-like syndrome following pars plana vitrectomy.

OBJECTIVE: To report two cases of a malignant glaucoma-like syndrome following pars plana vitrectomy. DESIGN: Two interventional case reports. INTERVENTION: The first patient was treated with a neodymium:YAG laser peripheral iridectomy with hyaloidectomy and with intracameral tissue plasminogen activator. The second patient was treated with a posterior approach iridectomy through residual hyaloid, zonules, and iris. MAIN OUTCOME MEASURES: Axial anterior chamber depth and intraocular pressure (IOP). RESULTS: The interventions resulted in deepening of the anterior chambers and normalization of IOPs. CONCLUSION: A pseudomalignant glaucoma syndrome may be related to obstruction of aqueous flow, either by residual anterior hyaloid or by fibrin and other inflammatory debris at the level of the ciliary body-zonular apparatus. Treatment of this syndrome involves restoring aqueous flow to the anterior chamber by disrupting the residual anterior hyaloid or clearing fibrin or inflammatory debris. The clinician should not disregard the possibility of a pseudomalignant glaucoma syndrome following vitrectomy despite the fact that vitrectomy has traditionally been considered a curative treatment for malignant glaucoma.     

Nd:YAG激光应用中对眼组织的损害及预防

目的:Nd:YAG激光在应用中所发生的并发症,系统分析了出现的原因,提出了治疗方法及预防措施。方法:2009-12/2012-12共计387例597眼激光爆破中对眼组织的损害:包括炎性反应,一过性高眼压,角膜内皮点状混浊,前房出血,人工晶状体损伤等,并对相关的指标进行了量化处理。结果:青光眼虹膜穿孔术:炎性反应93.7%,一过性高眼压78.9%,前房出血23.7%,虹膜后粘连2.63%,虹膜根部断离0.53%,视网膜出血0.53%。人工晶状体前膜切开术:炎性反应20%,一过性高眼压33.3%,前房出血46.7%,人工晶状体损伤33.3%。人工晶状体后囊膜切开术:炎性反应19.2%,一过性高眼压17.8%,前房出血0.3%,人工晶状体损伤26.0%。结论:Nd:YAG激光在眼前节中的治疗作用是安全确实的,其对眼组织的损害与机器性能,操作者的经验,疾病的种类及程度,患者的配合等密切相关,了解了这些因素有针对的干预可避免或减少对眼组织的损害。     

Intrastromal epithelial cysts of the iris: two case studies

AIM: Intrastromal epithelial cysts, congenital or acquired, are rare tumors of the anterior chamber. We report two cases, one in a 4-Month-old girl and one in a 14-Year-old teenage girl. MATERIAL AND METHODS: In the infant case, a large cyst with a superior base obstructed the visual axis. The child had already developed amblyopia and intermittent esotropia, with normal ocular pressure. Aspiration of the cyst with complete excision was done without iridectomy. Two Years later, a secondary corectopia required an inferior iridectomy. Finally, 4 Years later, endophthalmitis developed on a corneal stitch, and the eye was enucleated. In the second case, the teenage girl had noticed a modification in her iris due to an inferior temporal iris cyst. The cyst was excised with a peripheral iridectomy. Despite a first complete excision, a recurrence the following Year was treated by Yag laser. One Year later, the clinical aspect was stable. COMMENTS AND CONCLUSION: These benign tumors present the problem of local extension and recurrence. Surgical treatment with iridectomy is often proposed despite eventual aesthetic or functional consequences. Yag laser may be a therapeutic alternative. The two operations reported here did not prevent recurrence. In conclusion, intrastromal epithelial cysts of the iris are rare and benign tumors that may induce local complications and lead to recurrence. Many treatments can be discussed for each case.