Nd:YAG激光联合倍频YAG激光行虹膜周边切除

目的:Nd:YAG激光联合倍频YAG激光做虹膜周边切除解除瞳孔阻滞,预防青光眼急性发作,观察临床效果。方法:1997-01/2001-12运用Nd:YAG激光联合倍频YAG激光做虹膜周边切除共治疗143例(167眼),随访3～26mo。结果:激光虹膜周边切除临床前期行86例(91眼);急性发作经治疗后缓解,房角部分开放者行23例(29眼);单纯浅前房者34例(47眼)。全部1次激光成功激穿,无1例虹膜切孔闭塞。激光并发症明显减少,激光能量消耗较少。结论:Nd:YAG激光联合倍频YAG激光做虹膜周边切除,既能达到止血及易于激穿,又能减轻炎症反应,减轻并发症的发生。     

Nd：YAG激光虹膜周边切除术62例临床观察

Ｎｄ：ＹＡＧ激光虹膜周边切除术６２例临床观察解放军第五医院眼科任西平，梁祖忠，张贤文，黄洁成我科于１９９２年４月至１９９３年１０月对６２例７６眼青光眼施行ＹＡＧ激光虹膜周边切除术，效果满意，现报告如下。材料和方法本组６２例７６眼中闭角型青光眼３５例４...     

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。     

Nd:YAG激光虹膜切开术治疗闭角型青光眼

80年代以来,Nd:YAG激光治疗闭角型青光眼,因其安全、简便、有效,已得到广泛的临床应用。我院自1994年对原发性闭角型青光眼进行虹膜周边切开术治疗,现将资料较完整的53例临床治疗报告如下。1　临床资料1.1　一般资料　53例(53眼)原发性闭角型青光眼,男21例,女32例,年龄47...     

Nd：YAG激光虹膜周边切除治疗青光眼

Ｎｄ：ＹＡＧ激光虹膜周边切除治疗青光眼山东省烟台毓璜顶医院眼科孙秋香，丁一心，王卿现将我院自１９９１年１１月以来使用西德Ｏｐｔｏｎ－ＶｉｓｕｌａｓＮｄ：ＹＡＧ激光治疗机对１２０眼闭角型青光眼虹膜周边切除治疗体会报告如下。临床资料共治疗青光眼１２０例１...     

YAG激光虹膜切除术预防青光眼急性发作

目的 探讨Ｎｄ：ＹＡＧ激光预防闭角型青光眼急性发作的意义。方法 应用ＹＡＧ激光治疗仪作虹膜切除术替代传统的开放式周边虹膜切除术,选择虹膜１点或５点方位虹膜中及外１／３处之隐窝区作切口,对原发性闭角型青光眼３０例行预防性手术,并进行随访观察。结果 术后经１－１２月观察,一次成功率８６．７％,二次成功率１００％。结论 该方法操作简便,经济快捷,安全无痛苦,ＹＡＧ激光虹膜切除术能预防闭角型青光眼的急性发     

联合倍频及Nd：YAG激光周边虹膜切开术

目的 观察联合应用倍频Nd:YAG和Nd:YAG激光对闭角型青光眼进行周边虹膜切开术的效果。方法 对82例（102眼）闭角型青光眼患,用倍频Nd:YAG激光对虹膜作一“蜂巢”状创口,用Nd:YAG激光切透虹膜。结果 联合激光1次虹膜切开成功101眼（99.02%)。术后3月眼压有所下降,并发症有虹膜切口出血2眼;切开孔1月后再闭锁1眼;角膜内皮损伤5眼;术眼均有不同程度虹膜炎,抗炎治疗可吸收,结论 联合激光周边虹膜切开术治疗闭角型青光眼效果确切,并发症发生率低。     

半导体激光联合YAG激光周边虹膜切除术治疗原发性闭角型青光眼

目的:探讨半导体激光联合YAG激光周边虹膜切除术治疗原发性闭角型青光眼疗效。方法:对89例110眼闭角型青光眼行半导体激光联合YAG激光周边虹膜切除术。结果:激光孔通畅100%,治愈98眼,好转8眼,无效4眼,总有效率96.4%。术前术后平均视力无明显变化。术后1wk眼压0.93～2.67(平均1.87)kPa。所有病例前房角均有不同程度的加宽。结论:半导体激光联合YAG激光周边虹膜切除术治疗原发性闭角型青光眼,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,值得临床推广。     

氟激光和掺钕钇铝石榴石激光联合应用进行周边虹膜切除术

为了探讨治疗闭角型青光眼的理想术式，对１５１例２００只原发性急、慢性闭角型青光眼，部分混合型青光眼行联合激光周边虹膜切除术。先用氖激光在术眼虹膜面作分层击射，达２／３～３／４基质层厚；然后用掺钕钇铝石榴石激光（ｎｅｅｄｙｍｉｕｍ：ｙｔｔｒｉｕｍａｌｕｍｉｎｕｍｇａｒｎｅｔ，Ｎｄ：ＹＡＧ）作穿透击射。虹膜透切率为１００．０％，１次透切成功率为９５．０％，术中、术后并发症的发生率明显较单独术式低。随访时间在２年以上者为１６１只眼。随访结果表明联合激光手术的远期疗效显著，是适宜于亚洲人虹膜特点的较为理想术式，建议在门诊推广应用。     

聯合倍頻及Nd:YAG激光周邊虹膜切開術

目的觀察聯合應用倍頻NdYAG和NdYAG激光對閉角型青光眼進行周邊虹膜切閉術的效果.方法對82例(102眼)閉角型青光眼患者,用倍頻NdYAG激光對虹膜作一"蜂巢"狀創口,用NdYAG激光切透虹膜.結果聯合激光1次虹膜切開成功101眼(99.02%),術後3月眼壓有所下降.并發癥有虹膜切口出血2眼;切閉孔1月後再閉鎖1眼;角膜内皮損傷5眼;術眼均有不同程度虹膜炎,抗炎治療可吸收.結論聯合激光周邊虹膜切開術治療閉角型青光眼效果確切,并發癥發生率低.     

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。     

Nd-YAG激光虹膜透切术后虹膜后粘连的防治探讨

本文探讨原发性闭角型青光眼85例(150只眼)Nd-YAG激光虹膜透切术后发生虹膜后粘连的影响因素,发现用缩瞳药的时间长短与药量大小是最根本的影响因素。粘连组术前后用药量均大于无粘连组,且激光前用药时间长,两者比较有统计学意义。激光前虹膜后粘连组视野缺损的患者比无粘连组多,随病程延长其病理损害也加重。虹膜后粘连主要影响患者视力及眼压的控制,也妨碍眼底检查及白内障摘出。在术后眼压和视力的比较中,两组差异有显著性。结果提示,选择适当的激光能量、术后加强局部激素的应用,早日散瞳,适当调整用药,可以防止后粘连的发生。     

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。     

掺钕钇铝石榴石激光后囊膜混浊切开对人工晶状体眼波前像差的影响

目的研究掺钕钇铝石榴石(Nd:YAG)激光后囊膜混浊切开对人工晶状体(IOL)眼波前像差的影响。方法对57例(68眼)白内障超声乳化吸除加IOL植入术后后囊膜混浊(PCO)患者行Nd:YAG激光后囊膜切开,激光前后应用NidekOPDScanⅠ角膜地形图/波前像差仪测量瞳孔直径为5.0mm时IOL眼的总像差、总高阶像差、球差、彗差和三叶草像差的均方根值(RMS),比较Nd:YAG激光前后波前像差的变化。Nd:YAG激光后囊膜切开采用环形切开向后翻转法,切开后囊膜瓣直径为5.0mm。结果激光术后最佳矫正视力较术前提高,差异有统计学意义(P<0.05)。激光术后总像差、总高阶像差、球差、彗差和三叶草像差的RMS分别为1.849±0.763、0.605±0.247、0.238±0.146、0.166±0.112及0.322±0.132,均较术前下降,差异有统计学意义(P<0.05)。结论 Nd:YAG激光后囊膜混浊切开直径5.0mm可以明显降低IOL眼的波前像差,改善视觉质量。     

Inflammatory effects of continuous-wave neodymium: yttrium aluminum garnet laser cyclophotocoagulation.

The uveal inflammatory response was studied in 31 rabbits treated unilaterally with neodymium: yttrium aluminum garnet (Nd:YAG) cyclophotocoagulation. Fifteen applications of 3.5-J energy were delivered to the dorsal and ventral perilimbal sclera using a contact continuous-wave system. On days 1, 3, 8, and 15, the inflammatory effects were assessed. Peak levels of aqueous humor protein (11 +/- 3 mg/ml), prostaglandin E2 (8.9 +/- 3.0 ng/ml), leukocytes (205 +/- 113/microliters), and iris-ciliary body myeloperoxidase activity (6.32 +/- 1.4 U/mg protein) occurred on day 3 and rapidly decreased between days 7 and 15. Vitreal protein levels also peaked at day 3 but remained elevated through day 15 (3.8 +/- 1.3 mg/ml). By contrast, aqueous erythrocytes were most numerous (22,614 +/- 10,517/microliters) on day 8. Levels of leukotriene B4 remained low in all eyes at all intervals. Correlative histologic changes were ciliary coagulation necrosis, severe vascular congestion, and a predominantly mononuclear inflammatory cell infiltrate. These data suggest that Nd:YAG cyclophotocoagulation in rabbits induces a relatively mild inflammatory response that is associated with significant vascular compromise. Although these observations may not be analogous to the situation in the human eye, they may provide a model with which to compare the relative effects of different treatment parameters to help establish the optimum protocol.     

激光周边虹膜切开术与周边虹膜切除术对血-房水屏障影响的对比研究

目的 探讨原发性慢性闭角型青光眼(PCACG)患者激光周边虹膜切开(LPI)与周边虹膜切除(SPI)术对血-房水屏障的影响.方法 临床随机对照试验.对60例早期PCACG患者,采用随机数字表法,随机分为LPI或SPI治疗组.应用FC-2000激光蛋白细胞检测仪定量测定术前、后的房水闪光值.同时观察眼压、中央角膜内皮细胞数、前房角粘连范围及其并发症.LPI组与SPI组房水闪光值比较,采用重复测量资料的两因素方差分析;应用Bonferroni法矫正检验水准α值后,进行组内两两比较的配对t检验.术后房水闪光值与眼压升高的相关性,采用Spearman秩相关分析法.结果 术前及术后第3天,1、2、3及4周,LPI组各观察时间点平均房水闪光值分别为(5.47±1.09)、(11.96±3.07)、(8.08±2.18)、(5.68±0.83)、(5.80±1.00)、(5.69±1.12)光粒子数/ms;SPI组分别为(5.43±1.13)、(8.44±3.22)、(6.42±1.77)、(5.35±0.71)、(5.53±1.26)、(5.45±1.23)光粒子数/ms.LPI组和SPI组术后第3天(t=-12.753,-8.101)及术后1周(t=-5.971,-3.870)房水闪光值均分别高于术前(P＜0.05),而且LPI组房水闪光值明显高于SPI组(t=4.329,3.231;P＜0.05).术后4周内,LPI组高眼压发生率高于SPI组(X2=5.079,4.022;P ＜0.05);术后第4周,LPI组平均应用局部降眼压药物种类数高于SPI组(Z=-1.984,P＜0.05).两组术后眼压升高与血-房水屏障损害程度呈正相关(r =0.899,0.833,P＜0.05).两组术后1周的平均中央角膜内皮细胞数(t=-0.696,0.008)和术后4周平均前房角粘连范围(Z=- 1.270,-1.490)与术前比较差异均无统计学意义(P＞0.05).两组术后各观察时间点均无明显并发症发生.结论 LP1和SPI术均影响PCACG患者正常的血-房水屏障,术后1周内LPI造成的影响较SPI更重,但术后2周基本恢复.早期血-房水屏障的破坏与术后的眼压波动相关,但对角膜内皮、前房角粘连无明显影响.     

Nd:YAG激光虹膜切除术与周边虹膜切除术的疗效比较

对56例71只原发性早期急性及慢性青光眼进行前瞻性研究随机分组,分别施行Nd:YAG激光虹膜切除术或周边虹膜切除术,术后随访1～3年,说明两种手术1年、2年及3年成功率(眼压≤2.8kPa)、术后眼压值、C值及CT值均无显著性差异。两种手术术后房角镜检查均各有82%的患者房角增宽到N2至W角水平,虽然下方房角小梁区的色素沉着,激光组(46.4%)远高于手术组(8.0%),但色素沉着对眼压控制率无明显影响。     

A comparison of neodymium: yttrium aluminum garnet and diode laser transscleral cyclophotocoagulation and cyclocryotherapy

The cyclodestructive effects of cyclocryotherapy and of the neodymium:yttrium aluminum garnet (Nd:YAG) and diode laser transscleral cyclophotocoagulation were investigated in phakic and pseudophakic cadaver eyes using a modified Miyake posterior-view technique and light microscopy. Cyclocryotherapy to -80 degrees C was applied with a 2.5-mm diameter tip, 1 and 2 mm from the limbus. Freezing at the ciliary processes was evident after 10-15 sec and reached a diameter of 3-4 mm by 30 sec. No visible changes were evident grossly in the ciliary processes, crystalline lens, or intraocular lens. Histologically increased separation of cells was observed. Effective noncontact Nd:YAG and diode laser applications to the ciliary processes were observed grossly as tissue blanching and shrinking and pigment dispersion. This effect was obtained by aiming 0.5-1.0 mm behind the limbus at a 1-mm defocus using 4 J of energy for the Nd:YAG and 1.2 J for the diode laser. The diode laser spot size did not affect the tissue response. No damage was observed in the crystalline or intraocular lens with either type of laser. Histologic changes using both lasers were coagulation necrosis with fragmentation and detachment of the ciliary body epithelium. This study suggested that the gross and histologic thermal effects produced by the diode and Nd:YAG laser were similar in the ciliary body. Also, at the time of surgery, these cyclodestructive procedures potentially cause little alteration of the crystalline or intraocular lens.