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。     

Nd:YAG激光虹膜切开术对葡萄膜炎继发性青光眼的眼压和前房的影响

目的：评价Nd：YAG激光虹膜切开术治疗葡萄膜炎继发性青光眼的临床效果。

方法：回顾性分析我院35例35眼葡萄膜炎继发瞳孔阻滞型青光眼经Nd：YAG激光虹膜切开术治疗的情况。随诊8～39(平均24.6)mo。

结果：患者35例35眼均一次激光完成虹膜切开术。术后3d,眼压控制在14～23(平均19.8±6.5)mmHg,与术前(43.5±10.3mmHg)相比,差异有统计学意义(t=2.421,P<0.05)。术后前房均明显加深,周边虹膜膨隆消失。术后2wk复查UBM,14眼房角重新开放,与术前相比,差异有统计学意义(χ²=12.78,P<0.01)。

结论：Nd：YAG激光虹膜切开术是治疗葡萄膜炎继发性青光眼的一种安全有效的方法,能避免此类患者房角永久性粘连。     

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。     

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.     

超声生物显微镜在青光眼激光周边虹膜切除术的应用

目的：应用国产超声生物显微镜（UBM）观察原发性闭角型青光眼行激光周边虹膜切除术的疗效。方法：原发性闭角型青光眼（包括急性、慢性）患者31例43眼,术前术后分别用UBM测量术眼中央前房深度（ACD）以及12：00,3：00,6：00,9：00四个方向的房角开放距离（AOD）及房角开放度数（AA）,并观察眼压。结果：术前术后眼压、中央前房深度比较无统计学差异,术前术后四个方向的AOD及AA均有增加,有统计学差异。结论：UBM能观察活体的手术前后的房角变化、激光通畅程度,为原发性闭角型青光眼的诊治提供了更有效的检查方法和疗效观察。     

氪激光周边虹膜成形术联合Nd:YAG激光虹膜切除术治疗早期闭角型青光眼的评价

目的观察联合激光(氪激光 Nd:YAG激光)的两种不同方法治疗早期闭角型青光眼在控制眼压、手术并发症及角膜内皮损伤的表现。方法共观察43人65眼,分为两组,A组采用局部氪激光虹膜成型 YAG激光虹膜周切术,B组采用180度虹膜成型 YAG激光虹膜周切术,观察术后1h、1周、4周及以上时间段的眼压、手术并发症和角膜内皮细胞的变化。结果两种手术方法在降低眼压方面均未见明显疗效,两组间亦未见统计学差异(P>0.05),B组的术后并发症明显小于A组(P<0.01),角膜内皮损伤B组在术后1h未见明显差异(P>0.01),两组在1周、4周及以上的时间观察到两组角膜内皮细胞数较术前明显减少,A组较B组更有显著减少(P<0.01)。结论联合激光手术在治疗早期闭角型青光眼虽然存在较单纯Nd:YAG手术较多的优越性,但并没有明显的降低眼压作用,较大范围的激光虹膜成型后产生的并发症和角膜内皮损伤明显减少,因此临床应用更应注重考虑远期角膜内皮细胞的受损情况。     

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。     

Nd:YAG laser iridotomy in pigment dispersion syndrome: an ultrasound biomicroscopic study

AIMS—Ultrasound biomicroscopy was used to study the shape of the iris and the iridolenticular contact in pigment dispersion syndrome (PDS) eyes, to compare them with matched normal eyes, and to assess the morphological effects of laser iridotomy in PDS eyes.
METHODS—50 eyes of 50 patients suffering from PDS (group 1), and 15 normal eyes of 15 subjects matched for age and refraction (group 2), were studied by ultrasound biomicroscopy (UBM, Humphrey-Zeiss). Nd:YAG laser iridotomy was proposed to the 30 PDS patients with concave iris and 18 underwent the treatment.
RESULTS—The iris was concave in 27 eyes in group 1, and three more eyes showed a concave iris during accommodation. Among normals, iris concavity was present in two eyes. The height of the iris convexity was −0.15 (0.24) mm (range −0.65 to +0.21), in the eyes of group 1, whereas it was +0.07 (0.10) mm (range −0.21 to +0.16) in group 2 (p<0.0012). Group 1 had greater iridolenticular contact than group 2: 1.55 (0.78) mm (range 0.30-2.88) and 1.07 (0.61) (range 0.30-2.50; p=0.0304). After laser iridotomy, only one eye still had a concave iris. Pre- and post-treatment deflections were −0.35 (0.18) mm (range −0.61 to -0.05) and +0.01 (0.06) mm (range −0.12 to +0.17), respectively (p<0.0001). Pre- and post-treatment iridolenticular contact was 2.10 (0.65) mm (range 0.70-2.88) and 0.93 (0.38) mm (range 0.4-1.75), respectively (p<0.0001). After laser iridotomy, the treated irises were flatter than normal (p=0.0207), whereas the iridolenticular contact was not significantly different.
CONCLUSIONS—Laser iridotomy can restore a normal iris shape and iridolenticular contact in eyes suffering from PDS.

Keywords: glaucoma; pigment dispersion syndrome; laser iridotomy; ultrasound biomicroscopy     

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。     

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.     

Malignant glaucoma following laser iridotomy

Background: A 69-year-old man presented with malignant glaucoma 10 days after an iridotomy for acute angle-closure glaucoma.
Methods: The case notes are reviewed, describing his presentation and treatment, including the technique of extracapsular cataract extraction with anterior vitrectomy.
Results: An excellent visual outcome was achieved with no recurrence of the malignant glaucoma.
Conclusions: This case illustrates the recently established link between laser iridotomy and malignant glaucoma. Miotics and other possible causes are excluded, a surgical option is described and the importance of assessing central anterior chamber depth in cases of angle closure is emphasised.     

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.     

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。     

YAG激光虹膜根部造孔术与恶性青光眼的预防

目的:探讨YAG激光与恶性青光眼的预防。方法:通过对恶性青光眼早期保守治疗无效的患者行YAG激光虹膜根部造孔术,从而使前后房沟通,促进前房形成。结果:对恶性青光眼早期保守治疗无效的患者行YAG激光虹膜根部造孔术,能阻止其发展。结论:YAG激光虹膜根部造孔能有效预防恶性青光眼的发生。     

选择性激光小梁成形术治疗原发性青光眼

目的评价选择性激光小梁成形术治疗原发性开角型青光眼(primaryopenangleglaucome,POAG)及原发性闭角型青光眼(prionaryangleclosureglaucome,PACG)虹膜周切术后残余青光眼的疗效和安全性。方法前瞻性、非随机性选择局部用药眼压不能控制的原发性开角型青光眼患者(13例16眼),或已行周边虹膜切除或激光虹膜打孔术,房角大部开放而眼压高的原发性闭角型青光眼患者(22例32眼)。应用选择性激光小梁成形术治疗。观察患者术后6个月眼压的变化。结果两组患者的眼压在激光治疗后均有显著下降:POAG组由术前的(25.3±3.9)mmHg降低至术后6个月的(18.0±4.2)mmHg;PACG组由术前的(23.9±3.0)mmHg,降低至术后6个月的(18.8±3.8)mmHg(1kPa=7.5mmHg)。术后暂时的眼压升高为最常见的并发症。结论选择性激光小梁成形术不仅可用于原发性开角型青光眼的治疗,也可以作为治疗残余闭角型青光眼的一种安全有效的方法。     

倍频Nd∶YAG激光联合YAG激光治疗闭角型青光眼

目的:观察倍频Nd∶YAG激光联合YAG激光行周边虹膜切除术治疗急性闭角型青光眼的疗效及并发症。方法:本组共105例,其中临床前期91眼,先兆期32眼,间歇期46眼,均先使用倍频Nd∶YAG激光在拟行周边虹膜切孔处分层射击,最后用YAG激光穿透造孔,随访12mo,观察疗效及并发症。结果:术后1～6h眼压暂时性升高,24h后眼压下降,虹膜周切孔均通畅,房角无粘连,3眼周切孔处局限性晶状体混浊。结论:倍频Nd∶YAG激光联合YAG激光行周边虹膜切除术是防止闭角型青光眼急性发作的安全有效的手术。     

Neodymium: YAG laser trabeculopuncture in open-angle glaucoma

Ten eyes of eight patients with open-angle glaucoma (OAG) had neodymium (Nd):YAG trabeculopuncture performed in an investigational protocol as an alternative to surgical intervention. In each, at four to six sites in the mid-trabecular meshwork, three to six superimposed applications were made (2 to 6 mJ). In four of six patients with adult OAG, a small decrease in intraocular pressure (IOP) was noted (from a mean of 25.5 to 20.0 mmHg after 3-4 weeks in the treated eyes, compared to no change at 21 mmHg in the fellow eyes). There appeared to be further attenuation of this IOP effect over the subsequent 2 to 11 months, and all patients demonstrated gonioscopic closure of all the puncture sites with time. One patient demonstrated an acute IOP elevation to 58 mmHg after the procedure, necessitating emergency filtration surgery. In contrast, in four eyes of two patients with juvenile open angle glaucoma, a dramatic lowering of IOP and improvement in tonographic outflow facility was demonstrated, although the effects were only temporary in one patient. YAG laser treatment to the trabecular meshwork may have its greatest potential usefulness when abnormalities in the uveal meshwork are involved, such as in certain cases of juvenile or congenital glaucoma, and may help identify the need for a surgical goniotomy. With more usual forms of OAG, however, widespread use of this technique should be avoided until greater efficacy can be achieved.