Does an iridotomy provide protection against narrowing of the anterior chamber angle during Valsalva maneuvre in eyes with primary angle closure

PURPOSE: To evaluate changes at the anterior chamber angle during Valsalva manoeuver, in eyes having primary angle closure (PAC) and a patent laser peripheral iridotomy. METHODS: Twenty-three eyes of 23 consecutive patients underwent a recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, iris thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva manoeuver was standardized to a pressure of 40 mmHg for 15 s, using a manometer.RESULTS:The mean baseline intraocular pressure changed from 18.86+3.79 to 26.73+4.73 mmHg during Valsalva, (P<0.0001). The anterior chamber angle recess narrowed from 16.62+6.24 to 6.5+4.02 degrees (P<0.0001). There was a significant increase in the thickness of the ciliary body from 0.92+0.25 to 1.17+0.31 mm (P=0.0006) and in the iris thickness from 0.47+0.17 to 0.57+0.11 mm (P=0.007). A significant increase in pupillary diameter (P=0.008) and a decrease in the angle opening distance (P<0.0001) also occurred during Valsalva, whereas there was no significant change in the anterior chamber depth (P=0.056). The angle recess during Valsalva had a positive correlation with the baseline anterior chamber angle (r=0.41, P=0.05) and a negative correlation with the ciliary body thickness (r=-0.52, P=0.046).CONCLUSIONS: The induction of Valsalva maneuver in day-to-day activities can lead to significant anterior segment angle shallowing and can lead to progression from the PAC stage to primary angle closure glaucoma in such predisposed eyes. The presence of a patent laser iridotomy may not prevent irido trabecular apposition during the Valsalva maneuver.     

急性原发性房角关闭对侧眼激光周边虹膜切除术后接触性房角关闭的研究

目的了解急性原发性房角关闭（APAC）对侧眼激光周边虹膜切除术（LPI）后接触性房角关闭的发生率和眼部解剖特征。方法前瞻性研究。选择54例APAC对侧眼没有虹膜前黏连（PAS）的患者作为研究对象,平均年龄（67．1±7．2）岁（54—83岁）。采用超声生物显微镜（UBM）在暗环境下观察LPI后是否发生接触性房角关闭．并比较发生接触性房角关闭与不发生接触性房角关闭患眼的眼压、房角及各项UBM参数,包括房角开放距离。（AOD跏）、房角隐窝面积,。（ARA750）、小梁虹膜夹角（T—I角）、小梁睫状体距离（TCPD）、周边虹膜厚度（IT1）、虹膜悬韧带距离（IZD）、虹膜根部附着位置、中央前房深度（ACD）。对两组数据采用独立样本t检验及两样本秩和检验进行分析。结果LPI后暗环境下UBM检查至少一个象限发生接触性房角关闭的有20例,占37％。反映房角开放程度的指标（AOD500、ARA750、T-I角）和反映睫状体位置的指标（TCPD）：接触性房角关闭（＋）组小于（-）组（t=11．741、11．089、12．175、4．349,P均〈0．01）;反映虹膜形态和位置的指标IT1：接触性房角关闭（＋）组大于（-）组（t=-3．300,P=0．002）;IZD、虹膜根部附着位置及ACD比较,两组差异无统计学意义（t=-1．880,P=0．066;Z=-1．423,P=0．155;t=0．072,P=0．942）。结论APAC对侧眼LPI后在暗环境下仍有一定比例发生接触性房角关闭,房角窄、睫状体前位、周边虹膜厚是LPI后发生接触性房角关闭的解剖学特点,提示LPI后具有这些解剖特点的APAC患者有可能进展为慢性房角关闭。     

The effect of laser iridotomy on the anterior segment anatomy of patients with plateau iris configuration

PURPOSE: To determine if laser iridotomy altered the anterior segment anatomy of patients with plateau iris configuration. METHODS: Twenty eyes of 9 female and 1 male patients were imaged using an ultrasound biomicroscope within 19 weeks before and 52 weeks after laser iridotomy. Measurements obtained included the anterior chamber depth (ACD), trabecular-ciliary process distance (TCPD), iris thickness (IT), angle opening distance at 500 micrometers (AOD), iridozonular distance (IZD), and trabecular-iris angle (TIA). Comparisons of the pre- and post- iridotomy measurements were made using a two-tailed paired t test. RESULTS: Laser iridotomy elicited no statistically significant change in ACD, TCPD, IT, AOD, or TIA. However, IZD was decreased (P < 0.05) in both eyes after laser iridotomy. Configuration of the irides was flat before and after laser iridotomies. CONCLUSION: This study suggests that laser iridotomy did not alter anterior segment anatomy, probably because of the fixed anterior insertion of the iris and ciliary body in plateau iris configuration. The decrease in IZD distance may be the result of a small posterior movement of the iris due to a reduction in relative pupillary block, secondary to laser iridotomy. The small reduction in relative papillary block in plateau iris configuration does not alter the width of the anterior chamber angle as measured by AOD and TIA.     

Mechanisms and treatment of primary angle closure: a review

Angle closure can recur following peripheral iridotomy in up to 58% of cases, due to plateau iris syndrome, lens disproportion or ciliary block. Ciliary block glaucoma is an important differential diagnosis of shallow anterior chamber, angle closure and high intraocular pressure, which may occur spontaneously or following laser or surgery. Some underlying mechanisms of ciliary block glaucoma remain poorly understood but lens-ciliary body apposition and anterior hyaloid changes with increased hydraulic resistance are major pathogenic factors. An understanding of the pathogenic factors facilitates early recognition of ciliary block glaucoma, and aids a logical sequence of intervention. We review the mechanisms of post-iridotomy angle closure and propose a stepwise treatment strategy for these conditions.     

The effect of yag laser iridotomy on the blood aqueous barrier in the rabbit

The effect of YAG laser iridotomy on the blood aqueous barrier in the rabbit was investigated in 21 eyes. In seven series, each containing three pigmented rabbits, the right eye received a YAG laser iridotomy in the upper nasal quadrant of the peripheral iris under standardized conditions utilizing the Mikroruptor II (Lasag Company, Thun/Switzerland). One of the parameters describing the blood aqueous barrier effects was the intraocular pressure, which was monitored at 10 min intervals. The iridotomy caused significant pressure increases in the treated eyes which was maintained up to 90 min following the laser procedure. The measurement of the protein concentration and the lactate dehydrogenase activity was done at equal time intervals after the iridotomy, on the basis of anterior chamber tapping of the treated eyes and the untreated control eyes. Over a period of 100 min after laser surgery, a positive correlation between time and protein concentration for the treated eyes (r = + 0.86) could be established. The activity of the enzyme lactate dehydrogenase in the treated eyes was increased within 5 min of the trauma, reaching a maximum 45 min after surgery, and the increase in activity level remained 150 min after surgery. The results indicate that the disturbance of the blood aqueous barrier with the YAG laser is not essentially different from that of the argon laser, although tissue damage may be more pronounced.     

The Q-switched ruby laser in glaucoma

A pilot study evaluated the safety and effectiveness of a Q-switched ruby laser in the treatment of both pupillary-block (10 eyes) and open-angle glaucoma (4 eyes). All patients had either poor visual acuity or had previously failed with conventional surgery. We created a patent iridotomy in all eyes, with one pulse in eight. Three of the four eyes with open-angle glaucoma had an intraocular pressure decrease of at least 15 mmHg after angle treatment. The major complication of Q-switched ruby iridotomy was blood and pigment within the anterior chamber obscuring the view of the iris. There were no apparent complications noted with Q-switched ruby angle treatment. The potential advantages, complications, and future uses of Q-switched lasers in glaucoma are discussed.     

Anterior pars plana vitrectomy in ciliary and iris block glaucoma

Ciliary and iris block glaucoma in aphakic and phakic eyes is characterized by the accumulation of aqueous humor in the vitreous cavity causing an increase in vitreous volume, a flattening of the anterior chamber, and an elevation of intraocular pressure. As vitreous blocks the space between the ciliary body and the iris or lens, respectively, an anterior vitrectomy via the pars plana is the logical surgical approach. This operation was performed in one phakic and 15 aphakic eyes with so-called pupillary block. The anterior chamber retained a normal depth in each case. Post-operatively the vitreous was found to be completely removed from the posterior chamber and the epiciliary space, rendering a free communication between the ciliary body and the posterior and anterior chamber. Early surgery in aphakic eyes with a flat anterior chamber resulted in a prompt normalization of intraocular pressure, whereas eyes with a block duration of over 4 weeks were at high risk of developing a secondary outflow resistance probably due to chronic angle closure.In part presented at the German Ophthalmological Society. Heidelberg, September, 1979     

Injurious effects on the rhesus monkey eye from dye laser iridotomy

8 normal rhesus monkeys were performed dye laser iridotomy in one eye and iridectomy surgery in the other. Another 7 normal rhesus monkeys were performed dye laser iridotomy in one eye and ruby laser iridotomy in the other. The protein content and the number of white blood cells in the aqueous humor, the intraocular pressure, and the ultrastructural changes in the pars plicata of the ciliary body and iris were observed after the operation. It was demonstrated that the intercellular space of the endothelium of the blood vessels in the iris might, like the intercellular space of the non-pigment epithelium in the pars plicata of the ciliary body, be the site of the blood-aqueous barrier of the eye. It was also shown that among these three modalities, dye laser iridotomy was the best, which induced the least injury to the blood-aqueous barrier with the shortest time for recovery and the least inflammatory reactions in the anterior segment of the eye.     

Clinical and pathologic-anatomical results following the application of a mobile argon-laser beam in aphakic pupillary block glaucoma (author's transl)

In the last four years we have treated with the mobile argon-laser beam 25 cases of aphakic pupillary block glaucoma (p. b. g.). According to the time of manifestation of the p. b. g. the patients were divided into an "early" and a "late" group. In the "early" group (17 eyes) the glaucoma manifested itself 1--4 days after cataract extraction. In the "late" group (8 eyes) p. b. g. appeared from 4 weeks to 3 years after cataract extraction. In 14 of the 17 cases of the first group we achieved a prompt reformation of the anterior chamber and a considerable decrease of intraocular pressure immediately after laser application. In 3 cases of the first group, where the pupil was under relative or absolute mydriasis before argon-laser treatment, the mobile laser beam failed to produce satisfactory results. In all of the 8 patients of the "late" group a reformation of the anterior chamber was achieved, but in only 4 of them did i. o. pressure normalize owing to extensive anterior synechiae. Laser application left either very slight or no traces at all on the iris. In order to ascertain the actual effect of the laser beam upon the iris, we applied laser under identical conditions in eyes which had no glaucoma but were to undergo enucleation because of choroidal melanoma. The histological examination revealed a slight degree of hyperaemia of the iris as an oedema of the connective tissue, while the iris sphincter did not appear to be affected by laser treatment.     

贝伐单抗兔眼前房注射后在眼组织的分布及其不良反应的研究

背景贝伐单抗已被广泛用于眼部新生血管性疾病的治疗,对眼前房注射后其药代动力学改变和安全性评价可为其治疗虹膜新生血管和新生血管性青光眼提供依据。目的观察前房注射贝伐单抗后药物在兔眼组织的分布并评价其安全性。方法20只健康新西兰白兔按随机数字表法分为2组,实验组左眼前房注射0．05ml贝伐单抗（1．25mg）,对照组左眼前房注射平衡盐溶液0．05ml。注射药物前后用裂隙灯及直接检眼镜检查眼前段和眼底表现并定期监测眼压、行角膜内皮镜检查并评估角膜内皮细胞计数的动态变化。前房注射后1、4、7、14、30d光学显微镜下行兔视网膜的组织病理学检查,注射后第4天和第30天透射电子显微镜下行兔视网膜的超微结构检查,应用免疫荧光染色法检测前房注射后不同时间贝伐单抗在眼组织中的分布情况。结果贝伐单抗前房注射后裂隙灯及直接检眼镜检查显示实验眼前后节组织和视网膜未见异常表现,实验组注药前后的眼压、角膜内皮细胞密度与对照组比较差异均无统计学意义（P=0．760,P=0．956）。眼组织病理学检查提示,实验组与对照组注药后角膜、晶状体、前房角、虹膜、睫状体、视网膜结构均未见异常改变;透射电子显微镜下实验组和对照组注药后角膜、晶状体、虹膜、睫状体超微结构无明显改变。免疫荧光染色显示,贝伐单抗前房注射后,注射眼和对侧眼的前房角、虹膜、睫状体、脉络膜和视网膜上均有红色荧光,对侧眼较注射眼荧光染色弱,红色荧光主要集中于血管壁和血管腔。贝伐单抗前房注射后第1天到第4天虹膜荧光染色最强,随后逐渐衰减,第30天仍有较弱的染色,注射后第7天睫状体染色较虹膜强,随后逐渐衰减,第30天仍有较弱的染色;注射后眼前房角染色最强的现象见于第4天到第7天,随后逐渐衰减,第30天消失。结论前房注射贝伐单抗1．25mg对正常兔眼组织无明显的毒性作用和不良反应,注射后药物能快速分布于注射眼的前房角、虹膜、睫状体、脉络膜和视网膜,主要堆积在血管样组织中。     

葡萄膜炎-青光眼-前房积血综合征的临床特征分析

目的 回顾分析葡萄膜炎-青光眼-前房积血(UGH)综合征的临床特征。设计回顾性病例系列。研究对象2018-2022年山东中医药大学附属眼科医院UGH患者8例(8眼)。方法回顾患者的病历资料,总结其临床表现、治疗方法及预后。主要指标临床表现及影像学检查结果。结果所有8例患者均为IOL植入术后1～6个月出现本病临床表现。平均眼压(42.91±11.54)mmHg,均存在不同程度的前房闪辉,前房积血4例,房水涂片存在红细胞4例。IOL偏位并与虹膜及睫状体接触,2例因虹膜后凹致IOL与虹膜后表面接触,4例IOL偏位与虹膜后表面接触,1例与睫状体接触。1例采用药物治疗,2例虹膜后凹的患者采用YAG激光虹膜切开,IOL调位术、IOL置换术、IOL取出术、青光眼阀植入术、睫状体光凝术各1例。治疗后随访6～46个月,前房闪辉及房水红细胞消失,IOL与虹膜及睫状体接触消失。结论UGH综合征的临床特征表现为白内障术后IOL与虹膜睫状体接触、眼压升高、前房闪辉、房水存在红细胞。其治疗以解除IOL与周围组织的摩擦为根本措施。(眼科,2023,32:127-132)     

Narrowing of the anterior chamber angle during Valsalva maneuver: a possible mechanism for angle closure

PURPOSE: To evaluate changes at the anterior chamber angle during Valsalva maneuver in eyes suspected to have a primary adult glaucoma. METHODS: Seventy-six consecutive patients underwent recording of applanation tonometry, measurement of the anterior chamber angle recess, angle opening distance, angle recess area, scleral spur-iris root distance, iris thickness, iridociliary angle, ciliary body thickness, anterior chamber depth, and pupil size on ultrasound biomicroscopy before and during the Valsalva maneuver. The Valsalva maneuver was standardized to a pressure of 40 mmHg for 15 seconds, using a manometer. RESULTS: The mean baseline intraocular pressure changed from 19.5+/-4.1 mmHg to 29.5+/-4.8 mmHg during Valsalva (p<0.0001). The anterior chamber angle recess narrowed from 17.9+/-9.5 to 7.8+/-9.2 degrees (p=0.0001). The angle recess area diminished from 0.15+/-0.14 mm2 to 0.14+/-0.12 mm2 (p=0.03) and the scleral spur to iris distance decreased from 0.19+/-0.2 mm to 0.16+/-0.18 mm (p=0.0001). The iridociliary angle narrowed from 72.6+/-33.5 degrees to 62.5+/-32.8 degrees (p=0.04). There was a significant increase in the thickness of the ciliary body, from 0.99+/-0.19 mm to 1.12+/-0.16 mm (p=0.001) and in iris thickness from 0.47+/-0.07 mm to 0.55+/-0.09 mm (p=0.0001). There was no significant change in the angle opening distance, anterior chamber depth, or pupillary diameter. A significant narrowing of the angle to less than 5 degrees was seen in 37 eyes, with iridocorneal apposition present in 28 eyes. After multivariate regression analysis it was found that the baseline ciliary body thickness and angle recess were significant predictors of narrowing of the angle (R2=96.1%). CONCLUSIONS: Significant elevation of the intraocular pressure, narrowing of the anterior chamber angle recess, thickening of the ciliary body, and increase in the iris thickness is seen during the Valsalva maneuver. The Valsalva maneuver may lead to angle closure in eyes anatomically predisposed to primary angle closure glaucoma.     

Creeping angle-closure glaucoma: The influence of iridotomy and iridectomy

In 16 patients (30 eyes) with creeping angle-closure glaucoma YAG laser iridotomy or surgical iridectomy was performed as part of treatment.
The initial characteristics of the affected eyes (refractive state, intraocular pressure, anterior chamber depth, iris contour, gonioscopic features, extent and severity of synechia formation and result of dark-room testing in six eyes) are recorded, and also the influence on these features of iridotomy or iridectomy. lntraocular pressure was reduced on average by 2.46 mmHg (1.72 mmHg in nontrabeculectomised eyes) (P<0.02), and anterior chambers deepened on average by 0.05 mm (P<0.05). Extension of peripheral anterior synechiae was recorded in nine eyes.     

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.     

Intraocular lenses. Histopathologic characteristics of a large series of autopsy eyes

Histopathologic changes in cornea, anterior chamber angle, iris and ciliary body of 119 autopsy eyes containing intraocular lenses are described and illustrated. Results are categorized according to type of intraocular lens (anterior chamber, iris fixation, iridocapsular, and posterior chamber), and methods of fixation are specified. Changes are categorized as: erosion, atrophy, proliferation of tissues and inflammatory reactions. In some instances, these histopathologic changes may provide a basis for understanding certain clinically evident complications.     

玻璃体切割术后早期高眼压的UBM临床观察

目的 通过超声生物显微镜（UBM）对玻璃体切割手术前后患眼进行检测比较,探讨玻璃体切割术后早期高眼压的发病机制。方法 应用UBM观察玻璃体切割手术前后患者眼前节结构的变化,分别比较有晶状体组、人工晶状体组术前术后各测量参数的变化。结果 高眼压组术后瞳孔阻滞,睫状体全周脱离、水肿、前旋。参数测量：有晶状体组的高眼压组与正常眼压组前房深度相比差异有统计学意义（t=2.000,P=0.049）,房角开放距离500高眼压组与正常眼压组相比差异有统计学意义（t=2.069,P=0.050）。人工晶状体组的高眼压组与正常眼压组前房深度相比有统计学意义（t=2.066,P=0.050）,高眼压组与正常眼压组睫状体厚度比较差异有统计学意义（t=1.926,P=0.037）。结论 术后睫状体水肿前旋致前房变浅、房角变窄,导致眼压升高,参数测量提示有晶状体高眼压组术后较术前有前房变浅、房角开放程度减小的趋势。     

孔源性视网膜脱离行巩膜外环扎和巩膜外加压术对眼球结构和眼压的影响

目的：观察巩膜外环扎术和巩膜外环扎联合巩膜外加压术对孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)患者眼球结构和眼压的影响。

方法：选取2014-05/2017-05在我院住院行手术治疗的RRD患者240例240眼,其中接受巩膜外环扎术100眼(巩膜外环扎术组),接受巩膜外环扎联合巩膜外加压术140眼(联合组)。术前、术后2、4、12wk,检测眼压、角膜厚度、角膜水平和垂直曲率、前房深度、晶状体厚度、眼轴长度、睫状体厚度及小梁虹膜夹角度数。

结果：术后12wk,两组患者240眼均获得解剖复位。术后2wk,两组眼压、角膜厚度、角膜水平和垂直曲率、晶状体厚度、睫状体厚度均较术前显著增加,前房深度及小梁虹膜夹角度数均较术前明显减小,差异均有统计学意义(P<0.05)。两组患者术后视力均较术前改善,且术后2wk联合组视力明显优于巩膜外环扎术组,差异均有统计学意义(P<0.05)。

结论：巩膜外环扎术和巩膜外环扎联合巩膜外加压术对角膜、前房、房角、晶状体厚度及小梁虹膜夹角度数在早期均有显著影响,巩膜外环扎联合巩膜外加压术对眼压的影响时间长,应予以关注。     

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。     

Iridociliary apposition in plateau iris syndrome persists after cataract extraction

PURPOSE: To evaluate the ultrasound biomicroscopic appearance of the anterior segment before and after cataract extraction in eyes with plateau iris syndrome and to determine the effect of postoperative zonular relaxation on ciliary body position. DESIGN: Interventional case series. METHODS: Eyes with plateau iris syndrome scanned before and after cataract extraction between January 1994 and September 2001 were enrolled. The iridociliary relationship and the anterior chamber depth at a distance of 3 mm from the scleral spur were assessed. RESULTS: We examined six eyes of six patients. Mean patient age was 74.2 +/- 6.4 years (standard deviation [SD]) (range, 65-81 years). Mean refractive error was + 1.0 +/- 3.9 diopters [D] (range, -5.75-+5.50), and mean axial length was 21.85 +/- 0.77 mm (range, 20.90-22.95 mm). All eyes had undergone laser iridotomy and argon laser peripheral iridoplasty before cataract extraction. Ultrasound biomicroscopy examination revealed a narrow angle and absence of a ciliary body sulcus in all eyes with focal areas of iridotrabecular apposition in three eyes. Following cataract extraction, the anterior chamber depth increased (P =.0006, paired t test), while the iridociliary contact remained unchanged. CONCLUSIONS: Iridociliary apposition persists after cataract extraction in plateau iris syndrome. Whether the cause is congenital or acquired, or both, remains to be determined.     

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。