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.     

激光周边虹膜切除术对角膜内皮细胞的影响

目的 探讨Nd∶YAG激光周边虹膜切除术对角膜内皮细胞的影响.方法 采用非接触式角膜内皮显微镜对40例Nd∶YAG激光周边虹膜切除术的患眼进行角膜内皮细胞的定性及定量观察.检测指标包括:所选区域平均细胞面积(AVE)、最大细胞面积(MAX)、最小细胞面积(MIN)、细胞密度(CD)、变异系数(CV)、细胞面积标准差(SD).激光治疗后1周、1个月、3个月、6个月随访,重复作角膜内皮细胞检查及眼科常规检查.采用SAS Version 9.12 Mixed Model统计分析比较激光治疗前与激光治疗后不同时期的角膜内皮细胞密度及形态的改变.结果 激光治疗前与激光治疗后不同时期的角膜内皮细胞密度、平均细胞面积、最大细胞面积、变异系数,细胞面积标准差均有统计学意义.而角膜内皮细胞的最小细胞面积激光治疗前后比较无统计学意义.结论 Nd∶YAG激光周边虹膜切除术对角膜内皮细胞有一定的损伤.     

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。     

改良激光虹膜成形术治疗高褶虹膜型青光眼

目的 评价改良的激光虹膜成形术治疗高褶虹膜型青光眼的疗效.方法 自虹膜中外1/3交界处开始向前房角方向依次行放射状光凝并在虹膜根部打微孔.用此方法治疗高褶虹膜型青光眼20例32眼.观察视力、眼压、房角、角膜内皮细胞密度及视野情况.结果 术后各随访时间点较术前眼压降低,差异有统计学意义(P＜0.01).术后周边前房深度增大,在1/3～1/2CT之间.术后各随访时间点角膜内皮细胞平均密度与术前对比,差异无统计学意义(P＞0.05).视力、视野较术前有所改善.结论 改良激光虹膜成形术治疗高褶虹膜型青光眼安全有效.     

Nd:YAG激光对角膜内皮的影响

目的 观察Nd：YAG激光对角膜内皮细胞的影响。方法 用角膜内皮细胞显微镜对Nd：YAG激光虹膜切除术以及后囊膜切开术的患眼进行角膜内皮细胞的观察。结果 所有患者激光术后14d，中央角膜内皮细胞密度（CD）减少具有统计学意义（P〈0．05）。激光虹膜切除术后14d，中央部位角膜内皮细胞密度减少，有统计学意义（P〈0．05）；术后7d，周边部5点处角膜内皮细胞平均细胞面积、最小细胞面积、细胞密度及六角形细胞百分率的变化均具有统计学意义（P〈0．05）。激光治疗后发性白内障后7d及14d中央部位及5点处角膜内皮细胞的各项检测指标的改变均无统计学意义（P〉0．05）；治疗前后患眼中央部位与周边5点处角膜内皮各项指标比较均无统计学差异，（P〉0．05）。结论 Nd：YAG激光周边虹膜切开术对角膜内皮有一定的损伤。2．6～3．2mj能量的Nd：YAG激光治疗后发障对角膜内皮细胞造成的损伤没有统计学意义。     

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。     

眼科激光对角膜内皮的影响

目的观察Nd：YAG激光及532nm激光对角膜内皮细胞的影响。方法用角膜内皮细胞显微镜分别对Nd：YAG激光周边虹膜切除术以及后囊膜切开术的患眼和532nm激光治疗中心性浆液性脉络膜视网膜病变（CSC）及糖尿病性视网膜病变（DR）的患眼进行角膜内皮细胞的观察。结果所有行Nd：YAG激光治疗患者激光术后14d,中央角膜细胞密度（CD）减少,具有统计学意义（P〈0.05）;激光虹膜切除术后14d,中央部位CD减少,有统计学意义（P〈0.05）;术后7d,周边爆破处平均细胞面积（AVE）、最小细胞面积（MIN）、CD及六边形细胞百分率（6A）的变化均具有统计学意义（P〈0.05）;激光治疗后发性白内障后7d及14d中央部位及爆破处角膜内皮细胞的各项检测指标的改变均无统计学意义（P〉0.05）。532nm激光光凝治疗CSC、DR后角膜内皮细胞的各项检测指标的改变均无统计学意义（P〉0.5）。结论Nd：YAG激光周边虹膜切开术对角膜内皮有一定的损伤。532nm激光治疗CSC及DR对角膜内皮细胞造成的影响没有统计学意义。     

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。     

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。     

改良激光虹膜成形术治疗慢性闭角型青光眼

目的 评估改良激光虹膜成形术治疗慢性闭角型青光眼的效果和安全性.方法 应用氪激光大光斑自虹膜中外1/3交界处开始向前房角方向依次进行放射状光凝,范围为360°周边虹膜.用此方法治疗慢性闭角型青光眼患者31例52眼.观察术后1 d、1周、1个月患者视力、眼压、角膜内皮细胞、前房角及术后并发症情况.结果 改良激光虹膜成形术术前平均眼压为(42.7±8.9)mmHg(1 kPa=7.5 mmHg);术后1 d、1周、1个月平均眼压分别为(15.3±8.2)mmHg、(14.4 ±11.1)mmHg、(14.8±13.2)mmHg,术后眼压与术前相比差异均有统计学意义(均为P<0.05).术后1 d、1周、1个月眼压≤21 mmHg者分别为45眼(86.5%)、43眼(82.7%)、41眼(78.8%).角膜内皮细胞平均密度术前为(2 683±248)mm-2,术后1周为(2 651±284)mm-2,术后1个月为(2 625±321)mm-2,术后1周、1个月与术前相比差异均无统计学意义(均为P>0.05).术后1 d、1周、1个月前房角累积开放范围>1/2周者分别为46眼(88.5%)、44眼(84.6%)、42眼(80.8%).术后所有患者均有不同程度的瞳孔变形(1周后减轻,1个月后有9眼未恢复)和虹膜炎症反应(用药3 d后减轻或消失).所有患者均无虹膜脱色素、出血、一过性眼压升高等并发症.结论 改良激光虹膜成形术治疗慢性闭角型青光眼可使关闭的前房角开放,眼压得到控制,且无明显角膜内皮细胞的损害.     

Laser peripheral iridotomy with iridoplasty in primary angle closure suspect: anterior chamber analysis by pentacam

Purpose

To compare conventional laser peripheral iridotomy (LPI) and LPI combined with laser peripheral iridoplasty in eyes with primary angle closure suspect (PACS) by assessment of anterior chamber dimensional changes using a Pentacam.

Methods

Forty-eight eyes of 24 subjects with bilateral PACS were recruited consecutively. Each eye was randomly allocated to treatment with conventional LPI, argon LPI only, or LPI plus iridoplasty, which consisted of simultaneous argon LPI and peripheral iridoplasty. Anterior chamber measurements were performed on each eye using a Pentacam, both before and after treatment. Mean anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle were measured, and topographic ACD analysis was performed. Results were compared between the two treatment groups.

Results

After treatment with either conventional LPI or LPI plus iridoplasty, the mean ACD and ACV increased significantly. Topographic ACD analysis revealed that the mid-to-peripheral ACD increase was significantly greater in the LPI plus iridoplasty group than in eyes treated with conventional LPI. Intraocular pressure changes and post-LPI complications did not differ between the groups.

Conclusions

Compared with conventional LPI, our study showed that LPI plus iridoplasty improved the mid-to-peripheral ACD increase. This procedure may have a role as an adjunct for reducing angle closure by simultaneously eliminating pupillary and non-pupillary block components.     

Laser iridoplasty in the treatment of severe acute angle closure glaucoma

Twenty eyes of 19 patients presenting with acute angle closure glaucoma (AACG) which failed to respond to medical treatment were treated with laser iridoplasty. In all 20 eyes, laser peripheral iridectomy (PI) was prevented by a hazy cornea. In all cases, iridoplasty resulted in a rapid and significant reduction in intraocular pressure. Laser iridoplasty appears to have a useful role in the management of medically unresponsive AACG, particularly in those cases where laser peripheral iridotomy (PI) has failed or is not possible to perform.     

Laser peripheral iridoplasty as initial treatment of acute attack of primary angle-closure: a long-term follow-up study

PURPOSE: To study the long-term clinical course and complications of patients with acute primary angle-closure treated with immediate laser peripheral iridoplasty followed by laser peripheral iridotomy. PATIENTS AND METHODS: Consecutive patients with acute primary angle closure treated with immediate laser peripheral iridoplasty, followed by laser peripheral iridotomy, at the Prince of Wales Hospital from July 1997 through January 2000 were followed up to document the clinical course of their disease and any complications from the laser treatment. Visual acuity, intraocular pressure, gonioscopic findings, corneal and lens clarity, iris appearance, pupillary reaction, and progression of glaucomatous optic neuropathy were evaluated. RESULTS: Thirty eyes of 29 Chinese patients with acute primary angle closure treated initially with either argon or diode laser peripheral iridoplasty were recruited. The mean follow-up period was 33.0 +/- 9.3 months. Twenty-one eyes (70%) had no further attack and maintained normal intraocular pressure without medications, and 9 eyes (30%) developed chronic angle-closure glaucoma with peripheral anterior synechiae. All eyes had pigmented laser marks on the peripheral iris, but none had peripheral corneal burn. CONCLUSIONS: Long-term follow-up data indicated that 30% of Chinese eyes with acute primary angle closure successfully treated with immediate laser peripheral iridoplasty followed by laser peripheral iridotomy developed peripheral anterior synechiae and an increase in intraocular pressure. There were minimal long-term complications on the cornea and the lens from the laser treatment.     

Argon laser peripheral iridoplasty (ALPI): an update

Argon laser peripheral iridoplasty is a useful procedure to eliminate appositional angle closure resulting from mechanisms other than pupillary block. For those eyes with angle closure originating at an anatomic level posterior to the iris, such as plateau iris, lens-induced angle closure, or posterior segment processes (malignant glaucoma, central retinal vein occlusion, etc.), laser iridotomy by itself may be insufficient to treat the underlying disease mechanism. Argon laser peripheral iridoplasty is often useful in these cases to further open the angle. It can be used to break an acute attack of angle-closure glaucoma and relieve appositional angle closure secondary to plateau iris syndrome, or lens-related angle closure, and to widen the angle prior to argon laser trabeculoplasty. Peripheral location of long-duration, low-power, large spot size laser burns is essential for optimal success.     

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.     

氩激光虹膜周边成形术治疗急性发作期原发性急性闭角型青光眼的疗效观察

目的观察氩激光虹膜周边成形术治疗原发性急性闭角型青光眼急性发作期的临床效果。方法将基础治疗1h后眼压≥50mmHg(1kPa=7.5mmHg)的103例(103眼)患者随机分为激光组52眼和药物组51眼。观察两组患者治疗前及治疗后30min、1h、2h、24h患者的症状、视力、角膜水肿程度、前房反应、周边前房深度、眼压降至21mmHg以下所用时间及24h后房角开放情况。结果治疗后激光组较药物组症状缓解明显,起效快;视力提高快、幅度大;两组患者周边前房都变深。两组患者治疗前后眼压差异均有统计学意义(均为P<0.05)。治疗后1h、2h两组患者角膜水肿程度为:激光组分别为1.48±0.62、1.37±0.53;药物组分别为1.69±0.67、1.57±0.59;两组比较差异均有统计学意义(均为P<0.05);治疗后30min和24h两组比较差异均无统计学意义(均为P>0.05);两组眼压降至21mmHg以下所用的时间:激光组(1.8±0.9)h,药物组为(6.5±2.2)h;24h后房角开放率激光组86.5%,药物组66.7%,两组比较差异均有统计学意义(均为P<0.05)。结论氩激光虹膜周边成形术是一种治疗原发性急性闭角型青光眼急性发作期的快速、安全和有效的方法。     

激光周边虹膜成形术联合白内障超声乳化治疗急性闭角型青光眼疗效分析

目的 研究激光周边虹膜成形术(LPIP)和白内障超声乳化吸除(Phaco)联合人工晶状体植入术对原发性急性闭角型青光眼的治疗效果.方法 对合并不同程度白内障的原发性闭角型青光眼急性发作患者54例61只眼随机分激光组(27例31只眼)和常规组(27例30只眼).激光组行LPIP,常规组以常规药物控制眼压,而后均行Phaco和人工晶状体植入术.比较两组眼压控制效果、前房角开放状况、瞳孔纵向直径、裸眼视力等.结果 两组治疗前的眼压差异无统计学意义(P＞0.05);治疗后0.5 h、1 h、2 h、4 h,两组眼压的差异均具有统计学意义(P＜0.05).Phaco联合人工晶状体植入术后1周、3月、6月,两组各时点眼压差异无统计学意义(P＞0.05).Phaco联合人工晶状体植入术前、术后6月,两组前房角开放状况的差异均具统计学意义(P＜0.05).Phaco联合人工晶状体植入术后6月两组瞳孔纵向直径、最佳矫正视力的差异有统计学意义(P＜0.05).结论 激光虹膜成形术联合白内障超声乳化吸除可更有效治疗原发性闭角型青光眼急性发作.

Abstract：

Objective To investigate the effect of laser peripheral iridoplasty (LPIP) combined phacoemulsification (Phaco) on attack of primary angle-closure glaucoma (PACG). Methods Sixty-one eyes of acute attack of PACG (54 consecutive cases) were divided into laser group (31 eyes of 27 cases) and routine group (30 eyes of 27 cases) randomly. Before phacoemulsification cataract extraction with intraocular lens implantation, eyes of laser group were performed LPIP'while eyes of routine group were administered routine drugs to control intraocular pressure (IOP). The effect of IOP depression, status of anterior chamber angle, perpendicular pupil diameter, and uncorrected visual acuity (UCVA) were compared between laser group and routine group. Results The mean IOP was no statistically difference between laser group and routine group pre-treated, but the mean IOP of laser group was reduced more rapidly than that af routine group. Ultrasound biomicroscopy discovered that LPIP could open closed anterior chamber angle more effectively. Compared with routine group, the perpendicular pupil diameter of laser group was smaller and the best corrective visual acuity' of laser group was better at 6 months post-phacoemulsification. Conclusions LPIP Combined with phacoemulsification cataract extraction can treat primary acute angle-closure glaucoma more effectively.     

氪激光周边虹膜成形术治疗青光眼急性发作的临床研究

目的探讨氪激光周边虹膜成形术治疗原发性闭角型青光眼急性发作的安全性和有效性。方法原发性闭角型青光眼第一次急性发作者，经检查确诊后立即给予1％匹罗卡品及0．5％噻吗心安点眼，1h后眼压仍不能下降至40mmHg以下者24例24眼行氪激光周边虹膜成形术，观察治疗前及治疗后30min、1、2、24h的症状、视力、角膜水肿、眼压及前房角变化。结果氪激光周边虹膜成形术30min后，眼压从42～81mmHg降至25～72mmHg，平均下降10．7％；术后1h眼压为15～47mmHg，平均下降58．2％；术后2h眼压为12～28mmHg，平均下降71．4％；术后24h眼压为9—18mmHg，均降至正常，平均下降82．7％。激光治疗后患者不适症状迅速缓解，视力快速提高，角膜水肿消退，前房角有不同程度的加宽。结论氪激光周边虹膜成形术能机械性拉开房角，迅速降低原发性闭角型青光眼急性发作期的眼压，起效快，并发症少，是治疗青光眼急性发作的一种安全有效的方法。