房角关闭机制指导下可疑原发性房角关闭患者激光干预的疗效评价

目的 根据房角关闭的不同机制,对可疑原发性房角关闭（PACS）患者行激光周边虹膜切除（LPI）术或LPI联合激光周边虹膜成形（LPIP）术,通过超声生物显微镜（UBM）评估PACS患者激光早期干预的疗效。设计 前瞻性病例系列。 研究对象2016年1月-11月在河北省邯郸市眼科医院连续就诊的PACS患者50例（65眼）。方法 根据房角关闭的不同机制,通过UBM评估患眼,对所有入选患眼均首先行LPI治疗,术后第3天复查UBM,检查提示仍存在至少一个象限房角呈接触性关闭的患者再进一步联合LPIP治疗。术后3天复查UBM,根据测量的相关参数的前后变化评价治疗效果。主要指标 UBM图像中的中央前房深度（ACD）,巩膜突前500 μm处的房角开放距离（AOD）、小梁虹膜夹角（TIA）、房角隐窝面积（ARA）、小梁睫状体距离（TCPD）、虹膜厚度（IT）。结果 65眼中,47眼（72.3%）行LPI治疗后3天UBM检查未发现存在至少一个象限的房角接触性关闭,术后AOD、TIA、TCPD、ARA较术前均明显增加（P均<0.01）,IT较术前无明显变化（P=0.465）;18眼（27.7%）行LPI术后3天,UBM提示存在至少一个象限的房角接触性关闭,联合LPIP治疗后AOD、TIA、TCPD、ARA较术前均明显增加（P均<0.01）,IT较LPI术后减少更明显（P<0.01）。结论 LPI后UBM可用于判断房角关闭的机制,并据此考虑是否联合LPIP,可进一步改善非单纯性瞳孔阻滞机制的可疑房角关闭患者的疗效。     

原发性闭角型青光眼激光周边虹膜切开术后前房角形态变化的一年观察

目的定量观察原发性闭角型青光眼(PACG)激光周边虹膜切开术(LPI)后前房角形态变化及周边虹膜前粘连(PAS)对LPI术后效果的影响。设计前瞻性病例系列。研究对象河北省邯郸市眼科医院连续的25例(39眼)PACG患者。方法患眼行LPI治疗。术前、术后2周、6个月、12个月时行眼科常规检查及超声生物显微镜(UBM)检查。根据末次随访时眼压情况分为眼压控制不良组(A组)及眼压控制良好组(B组)。各随访时间点的UBM参数进行重复测量的方差分析,组间比较采用配对t检验及Wilcoxon检验。主要指标UBM图像中测量的前房角参数。结果平均随访时间为(386.4±36.7)天。LPI术后2周、6个月及12个月的房角开放距离(AOD)、小梁虹膜夹角(TIA)、虹膜隐窝面积(ARA)较术前增加均有统计学意义(P均<0.001)。小梁睫状突距离(TCPD)术后12个月较术前增加具有统计学意义(P<0.001)。B组AOD500、TIA500、ARA500及TCPD均大于A组(P均<0.05),而PAS钟点范围少于A组(P=0.01)。结论 LPI能显著增宽PACG患者的周边前房角,但PAS的范围对LPI的效果起到明显的制约作用。     

YAG激光虹膜周边切开术联合非穿透性小梁切除治疗闭角型青光眼

目的 观察YAG激光虹膜周边切开术联合非穿透性小梁切除术(NPDS)治疗单纯瞳孔阻滞型闭角型青光眼的疗效.方法 对2002年1月至2004年10月收治的21例(35只眼)单纯瞳孔阻滞型闭角型青光眼进行YAG激光虹膜周边切开术联合非穿透性小梁切除术,分析手术前后眼压的差异及术后各个随访期的手术成功率.随访期10～36月,平均(18.77±10.47)月.结果 术前平均眼压(25.57±4.92)mmHg,术后3月、6月、12月、24月和36月的眼压分别为(13.34±4.18)mmHg、(14.49±2.83)mmHg、(14.92±4.57)mmHg、(16.77±3.45)mmHg、(17.32±4.17)mmHg.术后3月、6月、12月、24月和36月的完全成功率分别为81.2%、78.1%、73.3%、69.0%、66.1%;部分成功率分别为82.4%、80.9%、74.7%、72.7%、70.1%.并发症有:微穿透6例,前房出血4例,低眼压3例,脉络膜脱离2例.结论 YAG激光虹膜周边切开术联合NPDS可作为治疗部分类犁的闭角型青光眼是安全有效地手术方式.     

原发性房角关闭眼激光虹膜切除术后UBM测量参数比较

目的:比较激光虹膜切开术前后原发性房角关闭(primary angle closure,PAC)眼超声生物显微镜(ultrasound biomicroscopy,UBM)参数。方法:对46例74眼PAC患者进行了一项前瞻性临床试验。平均年龄58,04±11.33(24.0-82.0)岁。所有病例行完整的眼科检查,前房角镜A超生物测量和超声生物显微镜检查(Vu-max,SonomedInc.,NY,USA)及24-2标准无色差视野检查(SAP,Humphrey Visual Field Analyzer-II i,Carl Zeiss Meditec Inc.,Dublin,CA,USA)。使用配对t检验评估基准和随访的平均值之间的变化。结果:激光周边虹膜切除术(laser peripheral iridotomy,LPI)术后,平均房角从8.02±4.61(0.10-19.60)度增加到17.66±6.39(0.10-32.70)度(P=0.000),房角开放距离500(angle opening distance 500,AOD500)从0.11±0.06(0.01-0.30)mm增加到0.23±0.07(0.13-0.50)mm(P=0.000),平均虹膜厚度(iris thickness,IT)从0.58±0.11(0.33-0.99)mm下降到0.52±0.10(0.25-0.77)mm(P=0.000)。小梁睫状突距离,虹膜睫状突距离和睫状体厚度均未发现显著统计学差异。结论:LPI术后PAC的白种人眼睛的AOD500,虹膜晶体距离和前房角增加,IT和虹膜晶体高度减少。这说明LPI解除了瞳孔阻滞,加深了前房,扩大了房角,减少了虹膜前凸和增厚。     

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.     

原发性前房角关闭激光周边虹膜切除术后前房角的改变

目的 利用超声生物显微镜(UBM)筛查原发性前房角关闭(PAC)眼,进行预防性激光周边虹膜切除术(LPI),比较LPI前后前房角形态变化,探索阻止PAC向原发性闭角型青光眼(PACG)进展的方法.方法 应用前瞻性干预性病例研究.对2009年12月至2011年3月遵义医学院眼科门诊的PAC患者(经UBM检查有1个位点以上虹膜小梁网暂时性接触者)进行LPI治疗,术后2周复查UBM.结果 (1)暗光线LPI前、后PAC发生率分别为96.43％ (27/28)、32.14％ (9/28),明光线下分别为67.86％ (19/28)、7.14％ (2/28),LPI后PAC发生率降低,差异有统计学意义(P＜0.05).(2) UBM参数变化情况:明、暗光线下AOD500、TIA术后较术前均增大差异有统计学意义(P ＜0.001),LPI后房角宽度增加;明、暗光线下ILCD术后较术前增大、ILA术后较术前减小差异有统计学意义(P ＜0.001),LPI后瞳孔L阻滞力降低;LPI后暗光线下ICPD术后较术前减小差异有统计学意义(P＜0.05),TCPD明光线下术后较术前增大差异有统计学意义(P＜0.05),提示LPI后有虹膜后陷、睫状体后移;暗光线下比较IT1,术后上方位点变薄差异有统计学意义(P＜0.05).结论 对尚未发生房角粘连的PAC行LPI治疗,能使PAC房角增宽,瞳孔阻滞力下降,阻止部分PAC向PACG进展,降低PACG的发生率.     

原发性闭角型青光眼单侧急性发作对侧眼激光虹膜周边切除术后随访研究

背景对于有房角关闭高危因素的眼,激光虹膜周边切除术（LPI）是首选的治疗方法,但可疑原发性房角关闭患者行LPI术后2年内仍有28％发生房角关闭,因此有必要了解影响LPI术后疗效的相关因素。目的观察原发性闭角型青光眼（PACG）急性发作眼的对侧眼行LPI后眼压及房角变化情况,分析与手术疗效相关的影响因素。方法回顾性分析单侧急性发作史的PACG患者（≥40岁）87例87眼,其对侧眼接受LPI,于术后1周,3、6、9、12个月随访眼压,并在裂隙灯下使用压陷式Goldmann单面房角镜观察LPI后颞、鼻、上、下各象限房角开放情况并按Shaffer房角分级标准记录,同时观察周边同位性房角关闭（AAC）范围以及周边房角黏连范围,与术前值进行比较。手术成功标准为：术后眼压在未使用药物情况下保持在6～21mmHg;并未出现青光眼特征性视神经病变及相应的视野缺损;无需任何抗青光眼药物或手术治疗。对影响LPI成功率的因素进行Cox多因素逐步回归分析。结果共完成随访并纳入分析79例79眼,其中男33例（41．8％）,女46例（58．2％）,年龄（61．4±0．4）岁。手术前后6个组眼压差异的总体比较差异有统计学意义（F=4．056,P〈0．01）,LPI术后各时间点的眼压均较术前降低,差异有统计学意义（P〈0．01）。房角除下方之外各象限及平均Shaffer级别有所增加,LPI术后1周、3个月和6个月与术前比较差异均有统计学意义（P〈0．05）;术后1周和3个月AAC范围较术前缩小,差异均有统计学意义（P〈0．05）,而术后6、9、12个月的AAC范围与术前比较差异无统计学意义（P〉0．05）。术后1年LPI成功者61例（77．2％）,术前眼压、房角各象限及平均Shaffer级别、AAC范围在LPI手术成功与失败病例之间差异有统计学意义（P〈0．01）。Cox逐步回归分析发现,AAC范围与LPI生存率之间具有相关性（Wald=48．150,RR=1．963,P〈0．01）,而术前眼压、房角各象限及平均Shaffer级别、年龄、性别与LPI生存率无明显相关性（P〉0．05）。结论PACG急性发作眼的对侧眼行LPI后可使房角增宽、眼压降低,术后成功率与术前AAC的范围有关,提示在考虑术前ACC范围条件下,LPI可以更有效地预防房角关闭的发生。     

超声乳化白内障吸出和IOL植入术治疗激光周边虹膜切除术后急性闭角型青光眼(英文)

目的:观察超声乳化白内障吸出术联合人工晶状体(IOL)植入治疗激光周边虹膜切除术后闭角型青光眼的治疗效果。方法:激光周边虹膜切除术后闭角型青光眼并白内障患者39例(39眼),被分为两组,Ⅰ组须用抗青光眼药控制眼压,Ⅱ组不须用抗青光眼药控制眼压,患者均行超声乳化白内障吸出和折叠式人工晶状体植入术,术后随访3mo。结果:两组术后最佳矫正视力均较术前显著提高(P<0.05)。术后3moⅠ组眼压为15.72±3.02mmHg,Ⅱ组为16.30±3.81mmHg,两组眼压均比术前明显下降,有显著性差别(P<0.05)。Ⅰ组中央前房深度由术前1.64±0.45mm加深至术后3mo的3.21±0.41mm,Ⅱ组中央前房深度由术前1.92±0.52mm加深至术后3mo的3.18±0.39mm,两组术后中央前房深度均比术前明显加深,有显著性差异(P<0.05),前房角明显增宽。结论:超声乳化白内障吸出和人工晶状体(IOL)植入术不仅能提高激光周边虹膜切除术后青光眼视力,而且可彻底解除闭角型青光眼的瞳孔阻滞。     

Outcomes following acute primary angle closure in an Asian population

Background:  Data regarding development of primary angle closure glaucoma (PACG) following acute primary angle closure (APAC) is conflicting. This study looks at outcomes after an APAC episode with a secondary aim to identify any risk factors that could predict progression to PACG.
Methods:  This is a retrospective review of the charts of consecutive patients who were diagnosed with APAC from December 2003 to June 2006. All were treated in a standard manner with initial intensive medical therapy or laser iridoplasty followed by early laser peripheral iridotomy within 24 h of presentation.
Results:  Forty-two eyes of 41 patients were analysed. The mean follow-up period was 27.3 ± 16.2 months. Nine eyes (21.4%) developed an increase in intraocular pressure (IOP) within a mean of 11.9 months (median 5 months) after resolution of APAC. Eight eyes went on to have trabeculectomy or glaucoma drainage device. At final follow up, the mean IOP of attack eye was 13.3 ± 2.92 mmHg. None of the eyes, including those that underwent surgery, required topical medication to control IOP. Thirty-eight eyes (90.5%) have BCVA of 6/6 to 6/12. The duration of symptoms before presentation ( P  = 0.00) and duration taken to abort the acute attack ( P  = 0.01) were found to be significantly associated with development of PACG.
Conclusion:  The results of this study suggest that outcomes following successful treatment of APAC may not be as poor as described previously. Early aggressive management of the acute episode may have a role to play in preventing development of PACG after APAC.     

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.     

激光周边虹膜成形术治疗青光眼急性发作

目的　评估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效果。方法　 2 1眼原发性闭角型青光眼第一次急性发作时以 2 %匹罗卡品、0 5 %噻吗心安滴眼液滴眼 ,立即行激光周边虹膜成形术治疗 ,15、3 0、60、90min后测量眼压。结果　激光周边虹膜成形术后 15min后 ,眼压从 3 9～ 68mmHg ,平均 ( 5 1 5± 9 4)mmHg( 1mmHg =0 13 3kPa) ,下降到 19～ 60mmHg平均 ( 3 6 1± 10 7)mmHg ,平均下降 3 0 % ;术后 3 0min眼压为 11～ 5 0mmHg ,平均 ( 2 9 6± 11 2 )mmHg ,平均下降 42 5 % ;术后 60min眼压 10～ 3 8mmHg ,平均 ( 18 9± 9 6)mmHg ,平均下降 63 3 % ;术后 90min眼压为 8～ 3 8mmHg ,平均 ( 17 1± 10 2 )mmHg ,平均下降 66 8% ;15眼术后 90min眼压≤ 2 1mmHg。结论　激光周边虹膜成形术治疗原发性闭角型青光眼急性发作是有效的。     

Prevalence and mechanism of appositional angle closure in acute primary angle closure after iridotomy

PURPOSE: A prospective observational case series to assess the prevalence of appositional angle closure in darkness among iridotomized Chinese eyes after acute primary angle closure (APAC) with the use of both clinical methods and ultrasound biomicroscopy. METHODS: Sixteen Chinese patients who had history of APAC and subsequent successful treatment with laser peripheral iridotomy were examined. Fourteen additional control subjects were studied. Gonioscopy and ultrasound biomicroscopic examination were performed in the dark. Gonioscopic appearance of the angle was assessed, and quantitative measurements of the angle from the ultrasound biomicroscopic images were taken. RESULTS: Of the APAC eyes 55.6% had appositionally closed angle clinically and in 38.9% only Schwalbe's line was visible on gonioscopy. Ultrasound biomicroscopy confirmed structurally different anterior segments between eyes with APAC and the control eyes. In particular, the trabecular-ciliary-process distances were markedly different between the two groups. CONCLUSION: This study documented a high prevalence of appositional closure in iridotomized eyes after APAC in Chinese patients. The anteriorly positioned ciliary body, as documented in these cases by ultrasound biomicroscopy, is the likely mechanism of the angle crowding in this patient population.     

Anterior segment morphology after laser iridotomy in primary angle closure suspects

Purpose

To evaluate and compare the changes in anterior segment parameters in primary angle closure suspects before and after laser peripheral iridotomy and intrasession repeatability of measurements before laser iridotomy as assessed by Scheimpflug‐Placido disc topographer.

Methods

Before laser iridotomy, 56 eyes of 56 primary angle closure suspect patients underwent anterior segment analysis with the Sirius Scheimpflug‐Placido disc topographer system using glaucoma analysis mode, which was repeated a week after iridotomy. Anterior segment parameters such as central anterior chamber depth, central corneal thickness, anterior chamber volume and iridocorneal angle were analysed before and after laser iridotomy and compared with paired t‐test. Three consecutive scans were obtained to assess the intrasession repeatability of measurements before iridotomy by a single examiner and intraclass correlation co‐efficient was calculated. Multivariate regression analysis was performed to evaluate the predictors associated with iridocorneal angle narrowing.

Results

Intraclass correlation co‐efficient values ranged from 0.982 for anterior chamber volume to 0.998 for the iridocorneal angle. After laser iridotomy, mean central anterior chamber depth increased from 2.14 ± 0.29 mm to 2.21 ± 0.28 mm (p = 0.04), mean anterior chamber volume increased from 96.2 ± 16.98 mm³ to 98.14 ± 15.87 mm³ (p < 0.0001) and mean iridocorneal angle widened from 33.38 ± 3.96° to 34.82 ± 4.27° (p = 0.01), compared with pre‐iridotomy status. There was no change in central corneal thickness, intraocular pressure or pupil diameter. Multivariate regression analysis model showed that at one week after iridotomy, iridocorneal angle opening was positively correlated with age (β = 0.773, p = 0.005) and anterior chamber volume (β = 1.308, p < 0.0001).

Conclusions

Laser peripheral iridotomy induces significant changes in the 3‐D anterior segment morphology in primary angle closure suspect patients. The Scheimpflug‐Placido disc topographer provides reproducible measurements of the iridocorneal angle and other parameters measured and hence, may become clinically useful for non‐invasive detection of potentially occludable angles. Predictors of iridocorneal angle widening after iridotomy were older age and anterior chamber volume.

     

激光周边虹膜切除术治疗原发性房角关闭的短期临床效果观察

目的:评价激光周边虹膜切除术(laser peripheral iridectomy,LPI)治疗原发性房角关闭(primary angle closure,PAC)患者的短期临床效果。方法:对诊断为PAC的患者33例49眼行LPI,观察术前、术后眼压及房角变化。结果:通过(9.9±4.8)mo的短期随访,LPI治疗前眼压(17.69±3.25)mmHg,治疗后终末眼压(16.33±3.42)mmHg,房角均有不同程度的加宽(100%);45眼眼压得到控制,有效率92%,4眼(8%)眼压控制不佳,其中1眼(2%)手术治疗,3眼(6%)予加降眼压药物治疗。结论:对于PAC患者,LPI治疗短期内对降低眼压、加宽房角有效。     

频域眼前节光学相干断层扫描仪(AS-OCT)对激光周边虹膜切开术后患者前房角结构定量检测

目的 利用频域眼前节光学相干断层扫描仪(anterior segment optical coherence tomography,AS-OCT)检测原发性闭角型青光眼及原发性房角关闭眼激光周边虹膜切开术后的房角参数,并探讨测量参数的选择及在青光眼患者筛查与随访中的临床意义.方法 选取原发性闭角型青光眼及原发性房角关闭患者共40例(55眼),其中原发性急性闭角型青光眼缓解期8例11眼,原发性急性闭角型青光眼临床前期20例(20眼),原发性房角关闭12例(24眼).应用频域AS-OCT量化评价激光周边虹膜切开术后房角结构,测量上方、下方、鼻侧、颞侧前房角(anterior chamber angle,ACA)、小梁虹膜夹角(trabecular-iris angle,TIA)、房角开放距离(angle open distance,AOD)、小梁虹膜空间面积(trabecular iris space area,TISA),对检查结果进行分析.结果 选取角膜内侧距巩膜突500 μm和750μm的点,分别测量上方、下方、鼻侧、颞侧四个方位的AOD、TIA、ACA、TISA,归为500系列和750系列.500系列及750系列TIA、ACA、AOD测量值均值均为颞侧最大,鼻侧最小;TISA测量均值下方最大、上方最小.Pearson相关性分析显示TIA500和ACA500(r=0.799、P=0.00)、TIA750和ACA750(r=0.799、P=0.00)、TIA500和TI-SA500(r=0.919、P=0.00)、TIA750和TISA750(r=0.920、P=0.00)均具有正相关关系.以TIA500为自变量x,TISA500为因变量y,得回归方程y=-0.300 +0.005x(F=1195,P=0.00),即TISA500与TIA500呈线性正相关关系.以TIA750为自变量x,TISA750为因变量y,得回归方程y=-0.440 +0.009x(F=854,P=0.00),即TISA750与TIA750呈线性正相关关系.750系列参数的变异系数在四个方位均小于500系列.结论 频域AS-OCT可用于原发性闭角型青光眼及原发性房角关闭患者术后的疗效评价与随访.在房角狭窄时,750系列参数变异系数更小,更具有临床应用价值.     

可疑性原发性房角关闭和原发性房角关闭与PACG解剖结构的比较

目的:探讨可疑性原发性房角关闭(primary angle closure suspect,PACS)、原发性房角关闭(primary angle closure,PAC)及原发性闭角型青光眼(primary angle-closure glaucoma,PACG)解剖结构的异同。方法:采用国际区域性流行病学眼科学会(International Society of Geographical and Epidemiological Ophthalmology,ISGEO)的分类系统,分为4组:正常对照组(47例47眼)、PACS组(157例157眼),PAC组(96例96眼)及PACG组(86例86眼)。应用NIDEK Echoscan US-1800型A型超声测量系统对被测者眼部解剖结构(前房深度、晶状体厚度、眼轴长度、晶状体相对位置)进行测量,各项均值进行组间差异比较。结果:正常人、PACS和PAC与PACG的年龄、晶状体厚度依次增高(P<0.05),前房深度、晶状体相对位置依次递减(P<0.05);与正常人相比,PACS和PAC与PACG除眼轴外其余的参数都有差异(P<0.05);与PACG相比,正常人、PACS和PAC的解剖结构参数都存在差异(P<0.05);但PAC与PACG两组相比,除前房深度、晶状体相对位置外,其余的各项解剖参数相比无统计学意义(P>0.05)。结论:从正常人、PACS、PAC到PACG的前房深度变浅、眼轴变短、晶状体相对位置靠前。前房深度、晶状体相对位置对PACG的早期诊断及预防有一定的临床价值。     

联合激光逐层透切法行虹膜周边切除术

目的探讨采用逐层氩激光光凝－Ｎｄ：ＹＡＧ激光透切的方法行虹膜周边切除术的疗效。方法使用Ｃｏｈｅｒｅｎｔ联合激光器对１００例１２６眼闭角型青光眼患者施行虹膜周边切除术。切孔部位选择在颞上或颞下或鼻上或鼻下周边部虹膜。先以小能量Ａｒｇｏｎ激光在切孔处预光凝,再以Ｎｄ：ＹＡＧ激光进行透切,如此２种激光交替反复使用,逐层进行光切,直至切穿为止。切孔直径控制在０．６～１．０ｍｍ。结果全部患者经１次激光治疗均成功获得虹膜切孔。术后１ｍｏ和１ａ时眼压均较术前明显降低（Ｐ＜０．０００１）。房角开放１／２以上者,其治愈率为９７．５９％,房角开放１／２以下者治愈率５５．８１％,二者有显著性差别（Ｐ＜０．０００１）。主要不良反应为术中虹膜出血、角膜损伤、前房炎性反应、术后暂时性眼压升高等,随访１ａ未发现晶状体混浊及切孔关闭。结论使用联合激光逐层透切法行虹膜周边切除可显著减少２种激光的能量,提高了手术的成功率,使激光手术操作方便、安全、可靠。