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。     

应用Nd:YAG激光行虹膜周边切开术对角膜内皮细胞影响的临床观察

目的 分析闭角型青光眼患者行Nd:YAG激光虹膜周边切开术时,角膜内皮细胞的变化及其相关影响因素.方法 对35例(58眼)闭角型青光眼,应用Nd:YAG激光行虹膜周边切开术,术前、术后1周及术后1个月分别用角膜内皮镜进行定量、定性观察及统计分析,包括角膜内皮细胞密度、细胞面积、变异系数、六角形细胞百分数.结果 46眼(79.31％)经一次激光治疗成功切透虹膜、12眼(20.69％)经二次激光治疗成功切透虹膜.58眼术前、术后1周及术后1个月角膜内皮细胞密度、平均面积、变异系数、六边形细胞百分数差异均无统计学意义(P＞0.05).结论 应用Nd:YAG激光行虹膜周边切开术对角膜内皮细胞无明显损伤,效果确切且安全.     

掺钕钇铝石榴石激光虹膜切开术治疗早期闭角型青光眼

采用Q开关Nd:YAG激光虹膜切开术治疗早期原发性闭角型青光眼39例51只眼。虹膜隐窝内击射所需能量与击射次数平均为8.5±4.1mj,1.9±0.9次,非隐窝内击射为15.5±4.7mj,3.2±0.9次(P<0.01)。随访3～11个月。以眼压≤2.79kPa(≤21mmHg)为标准。成功率:78.9%,总有效率为94.7%。从眼压、C值及24小时眼压波动等方面评价疗效,并讨论了操作技术及经验。     

氩激光和Nd：YAG激光联合虹膜切除治疗葡萄膜炎继发闭角型青光眼

目的 探讨葡萄膜炎瞳孔闭锁继发闭角型青光眼的激光治疗.方法 对9例(9只眼)葡萄膜炎继发闭角型青光眼行氩激光和Nd:YAG激光联合虹膜切除术.在选择虹膜切除的部位先用氩激光在虹膜表面行分层击射,使虹膜收缩、部分炭化,后用Nd:YAG激光作穿透击射,形成一个1～1.5mm的虹膜根切孔.结果 术后随访4～16个月,9只眼激光虹膜切除孔均保持通畅,眼压控制良好,除1只眼术中虹膜少量出血,余无其他并发症.结论 氩激光与Nd:YAG激光联合行虹膜切除术是治疗葡萄膜炎瞳孔闭锁继发闭角型青光眼的一种安全有效的方法.     

Nd：YAG激光虹膜切除治疗早期闭角青光眼

用国产Q开关Nd:YAG激光机对92只早期闭角青光眼施行虹膜周边切除，切口直径0.3-0.5毫米，所需能量228.4±196.5mj，击射次数16.5±13.4次，激光虹膜切除术后一个月暗伏试验转阴率平均为82.05%，术后随访期为1-12个月，结合眼压和暗伏试验评价疗效，本组总有效率为85.4%。     

葡萄膜炎继发性青光眼治疗探讨

目的:探讨葡萄膜炎继发性青光眼的治疗疗效。方法:对本院1999-01/2005-12收治的36例葡萄膜炎继发性青光眼患者,进行回顾性研究。结果:葡萄膜炎继发性青光眼患者36例(42眼),其中前葡萄膜炎28例,全葡萄膜炎7例,Fuchs综合征1例。非手术治疗组(12例)中2例眼压控制不良5mo后行小梁切除术。手术治疗组(24例)中22例眼压控制满意。结论:非手术以首次发作或反复发作治疗及时,虹膜粘连时间短者疗效显著,小梁切除术或青光眼阀植入术对葡萄膜炎继发性青光眼均有效,但要注意控制葡萄膜炎炎症。     

氪激光/Nd:YAG激光联合应用于周边虹膜切除术

目的探讨氪激光/Nd:YAG激光联合应用于周边虹膜切除术的临床疗效.方法对18例26眼有适应证的患者进行氪激光/Nd:YAG激光联合应用于周边虹膜切除术,观察术中能量、术中及术后并发症,并与单纯YAG激光治疗周边虹膜切除术进行比较.结果氪激光/Nd:YAG激光联合应用组1次透切成功25眼,前房出血3眼,前房葡萄膜反应极轻,无视力影响及角膜晶状体损伤.结论氪激光/Nd:YAG激光联合应用于周边虹膜切除术具有并发症少,总能量低,1次透切率高的优点.     

Q-开关Nd:YAG激光虹膜切除术治疗闭角型青光眼的疗效观察

目的:观察Q-开关Nd:YAG激光治疗闭角型青光眼的疗效。方法:收集212例236眼门诊及住院闭角型青光眼患者,其中原发性闭角型青光眼204例228眼,葡萄膜炎继发青光眼8例8眼,进行Q-开关Nd:YAG激光虹膜切除术,非接触压平眼压计测量眼压,观察Q-开关Nd:YAG激光虹膜切除术后临床效果。结果:随诊3～24mo,激光虹膜切除术治疗前眼压均值21.36mmHg,治疗后终末眼压均值19.25mmHg,眼压控制良好219眼,有效率92.8%,配合降眼压药物治疗,眼压控制正常11眼(4.7%),眼压升高6眼(2.5%),再次激光无效后行小梁切除术。激光治疗术后前房加深,房角有不同程度加宽,视野未明显改变。结论:Q-开关Nd:YAG激光虹膜切除术是一种治疗闭角型青光眼安全有效的方法。     

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。     

Nd：YAG激光及其联合氩激光虹膜切开术后虹膜病理组织…

对２５只青紫蓝兔４２只眼行激光虹膜切开术（Ｎｄ：ＹＡＧ激光，氩激光及Ｎｄ：ＹＡＧ激光联合氩激光虹膜切开），借助光镜，透射电镜及扫描电镜观察比较术后即刻至８个月击射位虹膜的组织结构改变。结果表明：（１）Ｎｄ：ＹＡＧ激光作用的靶组织的内部张力较组织厚度对治疗效果的影响更大。（２）兔眼＜２００μｍ的氩激光，Ｎｄ：ＹＡＧ激光联合氩孔均在术后１周内关闭。病理组织学检查显示，氩激光孔的色素上增殖，迁移征象更为     

Q开关Nd:YAG激光与传统周边虹膜切除术的疗效观察对比

目的:比较Q开关Nd:YAG激光与手术周边虹膜切除术的临床疗效。方法:对行Nd:YAG激光周边虹膜切除术的108眼与传统周边虹膜切除术的78眼进行回顾性分析,比较术后眼压、视力、前房深度、并发症等情况。结果:随访6mo,两组术后眼压控制情况比较无显著差异性,术后视力激光治疗组优于手术组(P<0.05)。结论:Q开关Nd:YAG激光周边虹膜切除术操作简便安全,术后恢复快且经济,但不能完全取代手术周边虹膜切除术。     

Nd:YAG laser iridotomy in uveitic glaucoma

Purpose : To determine the survival of Nd:YAG laser peripheral iridotomy in those patients with angle closure glaucoma and iris bombé associated with uveitis. Methods : A retrospective review was performed on 11 patients of the Ocular Immunology Clinic of the Royal Victorian Eye and Ear Hospital who presented with uveitis, iris bombé due to extensive posterior synechiae and angle closure glaucoma. The date of iridotomy and where poss‐ible the degree of inflammation were noted, as was the date of failure of the iridotomy. A control group was constructed consisting of 65 patients who presented with acute angle closure glaucoma without a history of uveitis, who underwent Nd:YAG peripheral iridotomy. The survival of the peripheral iridotomies in the two groups was calculated using Kaplan–Meier survival analysis. Median survival was compared using log–rank test. Results : In the study group of 11 patients, 28 iridotomies were performed on 15 eyes; of these 28 iridotomies, 17 failed. Using Kaplan–Meier survival analysis the median time to failure was 85 days. In the control group of 65 patients, 66 iridotomies were performed on 66 eyes. None of the iridotomies in the control group failed. There was a significant difference in the survival of the Nd:YAG iridotomies (P = 0.00015) between groups. Conclusion : There is a high early failure rate of Nd:YAG iridotomies in patients with angle closure glaucoma and iris bombé associated with uveitis.     

Q-switched neodymium:YAG laser iridotomy

Twenty phakic eyes of 19 patients underwent Q-switched neodymium:YAG laser iridotomies for angle-closure glaucoma. Eleven eyes were previous argon laser failures. Penetration was achieved in each case with several shots in one session. Complications were minor and transient.     

Comparison of laser iridotomy using short duration 532-nm Nd: YAG laser (PASCAL) vs conventional laser in dark irides

AIM: To evaluate the outcome of laser iridotomy using 532-nm Nd: YAG laser (PASCAL) with short pulse duration and Nd: YAG laser compared to conventional combined laser iridotomy. METHODS: Retrospective, nonrandomized, comparative case series. Forty-five eyes of 34 patients underwent laser iridotomy. Twenty-two eyes underwent iridotomy using short duration PASCAL and Nd: YAG laser, and 23 eyes underwent iridotomy using conventional combined laser method. The average settings of PASCAL were 60 μm and 700-900 mW with a short duration of 0.01s to reduce the total applied energy. The conventional laser was 50 μm and 700-900 mW for 0.1s. After photocoagulation with these laser, the Nd: YAG laser was added in each group. Endothelial cell counts of pre-iridotomy and 2mo after iridotomy were measured and compared. RESULTS: All eyes completed iridotomy successfully. The total energy used in the PASCAL group was 1.85±1.17 J. Compared to conventional laser 13.25±1.67 J, the energy used was very small due to the short exposure time of PASCAL. Endothelial cell counts were reduced by 0.88% in the PASCAL group and 6.72% in the conventional laser group (P=0.044). The change in corneal endothelial cell counts before and after iridotomy was significant in conventional combined laser iridotomy group (P=0.004). CONCLUSION: Combined PASCAL and Nd:YAG laser iridotomy is an effective and safe technique in the dark brown irides of Asians. Furthermore, the short duration of exposure in PASCAL offers the advantages of reducing the total energy used and minimizing the corneal damage.     

Nd:YAG激光治疗后发性白内障

目的评价Ｎｄ：ＹＡＧ激光后囊膜切开术治疗后发性白内障的疗效及安全性。探讨防止其并发症的有效方法。方法对９７例１１２眼后发性白内障行Ｎｄ：ＹＡＧ激光后囊膜切开术,随访、观察８～１６ｍｏ,并进行分析、讨论。结果截囊成功率１００％,增视率９８．２％,术后视力恢复≥０．５者７６眼,占６７．９％．并发症仅有术后眼压暂时性升高１５眼占１３．４％,轻度人工晶状体损伤６眼占７．８％．结论Ｎｄ：ＹＡＧ激光后囊膜切开术是治疗后发性白内障最安全有效的方法。准确瞄准和聚焦、低能量、射击次数少、后囊膜小切孔可有效防止其并发症     

掺钕─钇铝石榴石激光虹膜切开术后房角结构改变及眼压变化

对16只青紫蓝兔32只眼行掺钕-钇铝石榴石（Nd：YAG）激光虹膜切开术，借助光镜、电镜观察术后即刻至8个月房角结构的改变。同时，临床观察术前后眼压的变化。结果显示，Nd：YAG激光虹膜切开术后，房角被纤维蛋白渗出物、组织碎屑、色素颗粒及红细胞吞噬时间推移通过房水引流即小梁滤过及细胞吞噬消化得以逐渐清除。术后一过性眼压升高可能与房角小梁网机械性堵塞有关，而非激光能量直接损伤小梁网所致。     

SD-OCT检测Nd:YAG激光周边虹膜切除术后黄斑区视网膜厚度变化

目的：探讨Nd：YAG激光周边虹膜切除术(LPI)对原发性闭角型青光眼(PACG)患者黄斑区视网膜厚度的影响。

方法： 前瞻性研究。选取2019-10/2021-10我院PACG患者30例30眼为PACG组,同期健康体检者20名20眼为正常对照组(随机选取一眼)。PACG组患者接受LPI治疗,术后随访1mo。两组受试者均行最佳矫正视力(BCVA)、眼压、角膜内皮细胞、IOL Master 500光学测量仪测量前房深度(ACD)及眼轴长度(AL)、频域光学相干断层扫描(SD-OCT)检查黄斑区视网膜厚度。比较两组受试者及PACG组患者LPI前后ACD、眼压、AL和黄斑区视网膜厚度,并行相关性分析。

结果：PACG组患者术后1wk,1mo ACD较术前变深(均P<0.05)。PACG组患者手术前后眼压和AL均无差异(均P>0.05)。PACG组患者术前黄斑中心区,内外环上方、颞侧、下方、鼻侧,共9个区域视网膜厚度分别为243.50±13.24、324.50±13.46、308.83±15.94、310.00±14.24、314.50±16.29、300.67±19.95、290.17±12.58、302.40±16.37、307.33±14.84μm,正常对照组相应部位分别为266.14±16.16、342.67±15.86、327.95±16.41、337.85±13.03、341.24±15.58、313.76±17.59、290.24±16.29、303.81±13.91、323.01±14.80μm,两组间中心区、内环上方、颞侧、下方、鼻侧比较均有差异(均P<0.05)。PACG组术后1wk黄斑区9个区域视网膜厚度分别与术前相比均增加,术后1mo接近术前水平,但手术前后各分区比较均无差异(均P>0.05)。

结论：与正常受试者比较,PACG患者黄斑区视网膜厚度较薄。PACG患者LPI术后早期黄斑区视网膜可变厚。     

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。