激光虹膜周边切除与虹膜周边成形治疗早期闭角型青光眼的临床观察

目的观察激光虹膜周边切除术和激光虹膜周边成形术对早期原发性闭角型青光眼的疗效。方法30名（50眼）早期闭角型青光眼的患者，按照UBM检查分组：虹膜膨隆型眼做Q开关Nd：YAG激光虹膜周边切除术（A组，18人，31眼）；虹膜高褶型眼做倍频Nd：YAG激光虹膜周边成形术（B组，12人，19眼）；激光术后1月停用降眼压眼液，前房角开放度无明显增加，并且眼压≥21mmHg者，改做激光虹膜周边切除术或激光虹膜周边成形术（C组，8人，10眼）。结果术后3个月30名患者的平均眼压和平均用药指数从术前的（21．8±3．1）mmHg和2．6±1．4降到（17．8±1．6）mmHg和1．0±0．90。A、B、C三组术后小梁虹膜夹角分别增加了10°、9°、11°，房角开放距离（AOD500）分别增加了0．17mm，0．19mm，0．22mm，差异均有非常显著意义（p〈0．01）。A、B、C三组术后瞳孔增大者分别为16％、53％、50％，视力下降者分别为13％、32％、30％。3组间比较，术后视力的变化差异无显著性（P〉0．05），术后瞳孔的变化差异有显著性（P〈0．05）。结论激光虹膜周边成形术对根部虹膜高褶的青光眼疗效较好。激光虹膜周边切除术对虹膜膨隆型青光眼疗效较好。对1种激光疗法效果不佳者可联合2种激光治疗。     

卡替洛尔对YAG激光周边虹膜切除术后眼压的影响

目的:观察20g/L卡替洛尔滴眼液是否能有效降低YAG激光周边虹膜切除术后眼压升高。方法:按相同的总能量进行匹配两组解剖学窄房角,YAG激光周边虹膜切除术患者64眼,其中一组术前2～3h曾滴用20g/L卡替洛尔滴眼液。记录术前、术后60min眼压。结果:YAG激光周边虹膜切除术后,两组中发生眼压升高眼数、眼压变化程度均无显著差异。结论:卡替洛尔滴眼液20g/L不能防止YAG激光周边虹膜切除术后眼压升高。     

周边虹膜切除与YAG激光虹膜切除术治疗早期闭角型青光眼的临床比较

目的 探讨周边虹膜切除术与YAG激光虹膜切除术对早期闭角型青光眼的疗效差异.方法 一组采用周边虹膜切除术,90例97只眼;另一组采用YAG激光周边虹膜切除术作对照组,167例193只眼,随访观察1个月至5年.结果 周边虹膜切除术组术后发现有3例残留虹膜色素层,激光组术后激光孔1例闭合,经再次激光扩大后,激光孔可见,未再闭合.另虹切组术后眼压控制超过20mmHg者4例,激光组术后眼压控制超过20mmHg的7例.结论 周边虹膜切除术与YAG激光虹膜切除术均能有效地治疗早期闭角型青光眼.介于激光痛苦小,费用低的特点,继发性瞳孔闭锁性青光眼以及绝大多数早期闭角型青光眼者,选择YAG激光优于周边虹膜切除术.但对于虹膜肥厚、色素较多者,周边虹膜切除术优于YAG激光虹膜切除术.对于虹膜高褶型青光眼,两种手术无显著差异.     

YAG组合激光机行周边虹膜切除术治疗早期闭角型青光眼173例

目的：运用YAG组合激光机对早期急、慢性闭角型青光眼行周边虹膜切除术，观察其临床疗效并进行分析。 方法：2000-01／2004-12运用YAG组合激光机对173例182眼早期急、慢性闭角型青光眼进行激光周边虹膜切除术。 结果：全部1次激光成功激穿，8眼激光术后有少量出血，1眼激光术后眼压轻度升高，1眼明显升高，给予对症处理；未见明显术后眼内炎症反应；远期眼压观察，23眼眼压在数周至数月内有升高，需进一步治疗。 结论：联合运用激光行周边虹膜切除术，成功穿透率高，且术后并发症明显减少，是有效可行的一种治疗青光眼的好方法。     

半导体激光360°虹膜周边成形术联合YAG虹膜周边切开术治疗闭角型青光眼

目的探讨半导体、YAG激光360°虹膜周边成形术联合虹膜周边切除术对闭角型青光眼的疗效。方法对96例151眼闭角型青光眼行半导体激光360°虹膜周边成形术联合YAG虹膜周边切开术。结果激光孔通畅100%,其中治愈115眼,好转34眼,其中3眼需两种以上眼药控制,2眼需行手术治疗。房角开放,周边前房加深,术前术后比较,有显著差异性(P<0.01)。不良反应有术后暂时性眼压升高,术中虹膜出血,角膜灼伤,前部色素炎性反应等。结论联合激光360°虹膜周边成形术及虹膜周边切除术,操作简单。效果确切,并发症少,是治疗闭角型青光眼的理想术式。     

超声生物显微镜在激光治疗闭角型青光眼对象选择及疗效评价方面的应用

目的探讨超声生物显微镜（ultrasound biomicroscopy,UBM）在激光虹膜周边切除术和激光周边虹膜成形术治疗早期闭角型青光眼选择对象和评价疗效方面的作用。方法32例48眼原发性闭角型青光眼的患者，按照UBM检查分2组：A组14例22眼，均为虹膜膨隆型，做Q开关Nd：YAG激光虹膜周边切除术；B组18例26眼均为虹膜高坪型，做倍频Nd：YAG激光虹膜周边成形术。结果术后3个月32例患者的平均眼压从术前的（22．2±3．4）mmHg（1kPa=7．5mmHg）降到（17．5±1．8）mmHg；平均用药指数从（2．5±1．5）分降到（1．1±0．8）分。激光治疗前后相比，A组和B组小梁虹膜夹角分别增加了7°和9°，房角开放距离（ADD500）分别增加了130μm和155μm，晶状体虹膜角分别减少了9°和6°，虹膜悬韧带距离分别减少了24μm和13μm，差异有明显统计学意义（P均〈0．01）。结论用UBM为激光虹膜周边切除术和激光虹膜周边成形术治疗早期闭角型青光眼选择对象和评价疗效是准确可靠的。[眼科新进展2007；27（3）：221．223]     

不同能量对YAG激光周边虹膜切开术后眼压的影响

目的：研究不同能量对激光虹膜周边切开术后眼压的影响。 方法：解剖学窄房角患者68例136眼行YAG激光周边虹膜切开术。记录术前眼压、术后60min眼压和术中总能量。根据总能量的百分位数,将病例分为高、中、低能量组,记录各组术后眼压升高低于5mmHg和高于5mmHg的例数。 结果：在术后眼压升高例数的比较上,低能量组与中、高能量组间有统计学差异（P<0.05）,中、高能量组间无统计学差异（P>0.05）。 结论：YAG激光周边虹膜切开术,在一定范围内术中使用总能量越低,术后眼压升高风险越低。但在总能量超过44mJ时,总能量与术后眼压升高风险无明显相关性。     

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。     

激光周边虹膜切除术后残余性闭角型青光眼的药物治疗效果

目的　探讨激光周边虹膜切除术后残余性闭角型青光眼的药物治疗效果。方法　对激光周边虹膜切除术后残余性闭角型青光眼患者 6 8例 (6 8只眼 )进行前瞻性临床对照研究。试验组应用 0 0 0 5 %拉坦前列素滴眼液每日滴眼 1次 ,对照组应用 0 5 %噻吗心安滴眼液每日滴眼 2次。随访 6个月 ,观察和比较两种药物治疗前、后患者的眼压、视力、视野及视乳头杯 /盘比值变化。结果　 6 8例中 ,有 5 6例 (82 4 % )完成 6个月随访。两组患者治疗前的基础眼压值比较 ,差异无显著意义(t=0 2 36 ,P =0 814 ) ;治疗后 3d ,各组眼压值与治疗前比较 ,差异均有显著意义 (两组间比较F =2 87 4 4 1,P <0 0 0 1,拉坦前列素组t=14 10 3,P <0 0 0 1;噻吗心安组t=10 30 8,P <0 0 0 1) ;各组随访患者药物治疗前、后眼压值比较 ,差异均有显著意义 (两组间比较F =74 2 5 9,P <0 0 0 1;拉坦前列素组F =14 8 787,P <0 0 0 1;噻吗心安组F =5 4 875 ,P <0 0 0 1)。治疗后两组间各个随访时间点的眼压值比较 ,差异均有显著意义 (t值分别为 - 6 12 7,- 5 930 ,- 6 2 0 1,- 5 931,- 7 4 12 ,- 6 6 4 0 ,- 6 75 6 ;均P <0 0 0 1) ;各组用药后不同随访时间点的眼压值与用药前比较 ,差异均有显著意义 (平均差异值 ,拉坦前列     

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     

Kataraktoperation mit Hinterkammerlinsenimplantation zur Behandlung des akuten Glaukoms

OBJECTIVE: The aim of this study was to compare phacoemulsification in eyes with angle-closure glaucoma to the partner eyes with or without iridectomy or laser iridotomy, respectively. METHODS: Twelve eyes with an elevated intraocular pressure due to an angle closure that were treated by phacoemulsification and IOL implantation were compared with 12 partner eyes with narrow angle and iridectomy or iridotomy without intraocular pressure elevation and cataract extraction. The average follow-up period was 15.7+/-2.1 months. RESULTS: The average intraocular pressure in eyes with angle-closure glaucoma was 54.1+/-14.7 mmHg and in the partner eyes 22.4+/-8.6 mmHg preoperatively. Follow-up pressure was 19.3+/-2.0 mmHg in eyes with angle-closure glaucoma and 18.8+/-1.5 mmHg in the partner eyes.CONCLUSION: Primary cataract extraction including posterior chamber lens implantation into eyes with angle-closure glaucoma reduced intraocular pressure to normal levels, increased visual acuity, and decreased the number of antiglaucomatous drugs. Eyes with angle-closure glaucoma do not respond differently to phacoemulsification and lens implantation compared to eyes with narrow angle without pressure elevation during and after phacoemulsification.     

Argon laser trabeculoplasty for chronic angle-closure glaucoma uncontrolled by iridotomy

Nineteen eyes of 19 Japanese patients with medically uncontrollable chronic angle-closure glaucoma following laser iridotomy or surgical iridectomy underwent argon laser trabeculoplasty (ALT), applying low-power and a small number of laser burns over a small extent of the trabecular meshwork. All the eyes had glaucomatous optic disc damage, visual field loss, and intraocular pressure elevation before ALT. In each case, the extent of peripheral anterior synechiae was equal or less than 50% of the angle. The mean follow-up was 35 months. Life-table analysis (Kaplan-Meier method) showed that the probability of success was 66% at the end of three years after ALT. It is concluded that in the cases of uncontrollable chronic angle-closure glaucoma following laser iridotomy or surgical iridectomy, ALT should be tried before filtration surgery.     

YAG激光虹膜周切术治疗药物难控制性急性闭角型青光眼

目的:探讨YAG激光周边虹膜切除术在药物难控制急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共124例124眼,其中男51例,女73例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21~35mmHg者51眼(41.1%),眼压36~50mmHg者37眼(29.8%),50mmHg以上者36眼(29.1%)。视力范围为光感~0.3。所有患者均在表面麻醉下行YAG激光周边虹膜切除术治疗,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行小梁切除术、青光眼白内障联合人工晶状体植入术,或单纯白内障超声乳化吸出联合人工晶状体植入术。结果:患者124例124眼急性闭角性青光眼患者行YAG激光虹膜周切术后,第2d检测眼压≤21mmHg者28眼(22.6%),眼压为22~35mmHg者60眼(48.4%),眼压36~50mmHg者25眼(20.2%),眼压>50mmHg者11眼(8.9%);激光术后视力增加3行者33眼（26.6%）,2行者31眼(25.0%),视力增加1行者44眼(35.5%),视力不增加者16眼(12.9%);119眼前房深度增加(96.0%); YAG激光虹膜周切术后并发前房出血98眼(79.0%)。眼压控制稳定后分别进行小梁切除术37眼,青光眼白内障联合人工晶状体植入术43眼,白内障超声乳化吸出联合人工晶状体植入术44眼。观察随访3~9mo,眼压控制≤18mmHg者95眼,眼压≤25mmHg者24眼,眼压为26~35mmHg者5眼,未见前房积血、黄斑囊样水肿等并发症。结论:YAG激光虹膜周切术在药物难控制性急性闭角型青光眼治疗中能明显降低眼压,为各种青光眼手术的治疗提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。     

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。     

激光虹膜切除联合超声乳化吸除术治疗急性闭角型青光眼合并白内障临床观察

目的 探讨急性闭角型青光眼初次发作后,采用激光周边虹膜切除,再行晶状体超声乳化吸出联合人工晶体植入术治疗的疗效.方法 分析2005年9月至2007年3月收治急性闭角型青光眼合并白内障患者16例,16只眼,应用激光周边虹膜切除术后,行晶状体超声乳化吸出联合人工晶体植入,观察术前及术后视力、周边前房深度、前房角、眼压情况.术后随诊4～12个月,平均9.4个月.结果 16只眼术后视力、周边前房深度较术前明显改善,前房角完全开放,眼压非药物控制于正常范围,平均眼压14.24mmHg.术后早期并发角膜水肿3只眼,前房纤维样渗出2只眼,无浅前房和后发障发生.结论 应用激光周边虹膜切除后,行晶状体超声乳化吸出人工晶体植入可有效治疗急性闭角型青光眼合并白内障,且术后视力恢复快、眼压控制好、并发症少.     

Additive intraocular pressure lowering effect of various medications with latanoprost

PURPOSE: To determine the additive intraocular pressure reduction of various topical glaucoma agents used adjunctively with latanoprost. DESIGN: Retrospective interventional case series. METHODS: Retrospective evaluation of 73 eyes of 73 patients with glaucoma and inadequate intraocular pressure control on latanoprost alone. Each patient received adjunctive treatment with an additional glaucoma agent (dorzolamide, brimonidine, timolol, or other beta-blockers) for 1 year. RESULTS: When added to latanoprost, dorzolamide lowered intraocular pressure an additional 3.9 mm Hg (19.7%, P <.001); beta-blockers further reduced intraocular pressure by 2.0 mm Hg (12.3%, P <.001), and brimonidine further reduced intraocular pressure by 2.0 mm Hg (9.3%, P =.0011). Dorzolamide dosed twice or three times daily was as effective as adjunctive therapy with latanoprost (P =.92). CONCLUSION: Adjunctive therapy with dorzolamide provided a statistically significant intraocular pressure reduction at 1 year in eyes that were inadequately controlled with latanoprost alone.     

A short-term study of the additive effect of latanoprost 0.005% and brimonidine 0.2%

PURPOSE: To evaluate the short-term additive effects of latanoprost 0.005% and brimonidine 0.2%. METHODS: This study was a randomized, double-masked, cross-over study that included 32 patients (32 eyes) with primary open-angle glaucoma or exfoliation glaucoma. On baseline day, intraocular pressure (IOP) was measured at 10 AM and 11 PM. Baseline IOP values were obtained by calculating the mean values for both eyes. After this process, latanoprost 0.005% was prescribed once a day during the first 5 days at 10 PM as the first test drug. During the second 5 days, twice a day brimonidine 0.2% or a placebo, as the second test drug, was added to the latanoprost at 9 AM and 10 PM. After a 4-week washout period, latanoprost 0.005% was prescribed once a day during the first 5 days at 10 PM and during the second 5 days, the second test drug, brimonidine or a placebo, was added to latanoprost, and the two drugs were prescribed twice a day for 5 days. RESULTS: During the second 5 days, although an additional 2.53-3.10 mm Hg decrease in IOP was determined in the latanoprost+brimonidine group, there was no additional decrease in the latanoprost+placebo group. CONCLUSIONS: This study showed that brimonidine and latanoprost have an additive IOP-lowering effect in open-angle glaucoma patients in the short term.     

激光周边虹膜成形及切除术治疗药物难控制的急性闭角型青光眼

目的：探讨激光周边虹膜成形联合周边虹膜切除术,治疗药物难控制的急性闭角型青光眼的效果和安全性。方法：选取药物治疗24h后眼压仍高于21mmHg的原发性急性闭角型青光眼15例17眼和白内障膨胀期继发的急性闭角型青光眼4例4眼,共19例21眼,采用激光周边虹膜成形联合周边虹膜切除术,术后24h观察视力、眼压、角膜、周边前房深度、房角及并发症。结果：所有患者激光术后24h眼压均有大幅度的下降,术前眼压53.09±11.01mmHg,术后24h眼压下降至14.98±4.21mmHg,治疗前后差异有统计学意义（P〈0.01 ）。术后视力由术前手动～0.3提高至0.1～1.0。所有患者角膜水肿减轻或消退,周边前房深度增加,房角不同程度开放。其中虹膜出血11眼（52.4%）,轻度反应性虹膜炎21眼（100%）,无1眼发生角膜灼伤。结论：激光周边虹膜切除联合周边虹膜成形术,是降低药物难控制的急性闭角型青光眼眼压的一种安全有效的方法。     

原发性急性闭角型青光眼合并白内障的联合治疗

目的探讨氪激光及Nd：YAG激光虹膜成形加打孔术联合超声乳化手术治疗原发性急性闭角型青光眼合并白内障的临床意义。方法对25例（25眼）急性闭角型青光眼合并白内障首次发作者,药物控制眼压后即行Nd：YAG激光及氪激光虹膜成型及打孔术,术后3～14d行超声乳化吸出联合人工晶状体植入术,观察治疗前及术后眼压、前房深度及视力,并用StratusOCT观察房角情况。随访3～12个月,结果采用配对t检验,SPSS10．0统计学方法分析。结果眼压由术前的（62．17±14．12）mmHg降至（14．32±3．17）mmHg,前房深度由术前（1．67±0．32）mm加深至（2．86±0．40）mm,房角明显加宽,术后视力明显提高。结论对首次发作的急性闭角型青光眼合并白内障,激光虹膜成形及打孔术联合白内障超声乳化手术可以有效的控制眼压,开放房角,提高视力。减少青光眼外滤过手术的并发症,减少创伤,改善视力,提高生活质量。     

激光虹膜周边切除术治疗慢性闭角型青光眼的远期疗效

目的观察慢性闭角型青光眼患者接受激光虹膜周边切除术（LPI）治疗的远期效果。方法对长期随访的66例（116眼）接受LPI的慢性闭角型青光眼患者进行回顾性研究,观察术前及术后的患者情况。结果20眼（17％）术后未用药,眼压控制在〈21mmHg;49眼（42％）经药物控制眼压正常;47眼（41％）用药情况下,眼压〉21mmHg,其中35眼接受进一步手术治疗。以术前眼压21mmHg为界将患眼分为2组。2组的LPI单独起作用者分别为17眼和3眼（χ^2=6．136,P=0．013）,青光眼失控者分别为15眼和32眼,差异有统计学意义（χ^2=26．68,P〈0．01）。结论对LPI术后慢性闭角型青光眼患者,尤其是术前眼压控制差的患者应密切随诊,以防止视功能进一步损害。